Patching

Engaging people from the community affected by the problem of obesity or its determinants allows for the inclusion of local wisdom from the outset in the adaptation of evidence-based practices and the creation of new ideas to be tested. As with any federal or state health program that must depend on local and state initiative and implementation, the process of rolling out a policy or taking a program to scale requires the engagement and participation of practitioners and populations at the front lines (Ottoson et al., 2009). Success will depend on continuous adaptation to their perception of needs; their understanding of and access to local resources; their willingness, skill, and confidence to implement the recommended intervention; and the reinforcement they will get from doing so (Ottoson and Green, 1987). Many of the methods for patching together evidence-based practices, theory-based programs, and practice-based experiences into a viable effort at the state or local level are contained in manuals and guidelines such as CDC’s Planned Approach to Community Health (PATCH; Kreuter, 1992) and Racial and Ethnic Approaches to Community Health, (REACH; CDC, 2009b); community-based participatory research (CBPR; Cargo and Mercer, 2008; Horowitz et al., 2009; Minkler and Wallerstein, 2008); the National Cancer Institute (NCI) and Substance Abuse and Mental Health Services Administration’s (SAMHSA) Cancer Control PLANET (NCI and SAMHSA, 2009); and other web resources that need to be made more interactive and responsive as the evidence changes (e.g., http://www.cdc.gov/nutrition/professionals/researchtopractice/index.html [CDC, 2009a]).

An obesity-related example of engaging community members in the planning, delivery, and evaluation of interventions is the Shape Up Somerville environmental change intervention, designed to prevent obesity in culturally diverse, high-risk early elementary school children in Somerville, Massachusetts. One outcome of this initiative was a decrease in BMI z-scores among children at high risk for obesity in grades 1-3, a result of an intervention that aimed to bring participants’ energy equation into balance by modifying the school, home, and community environments to increase both physical activity options and the availability of healthful foods (Economos et al., 2007). Community members and groups engaged in the intervention included children, parents, teachers, school food service providers, city departments, policy makers, health care providers, restaurants, before- and after-school programs, and the media. Another strategy of Shape Up Somerville was to improve school food service, which led to changes that enhanced the nutrient profiles of and attitudes toward school meals. The engagement of students, parents, teachers, school leaders, and food service personnel was an integral part of the process (Goldberg et al., 2009). There is also a growing literature on how to combine systematic reviews of quantitative and qualitative evidence with realist reviews of theoretical assumptions and with the practical experience of those who must make the final decisions on local action (Ogilvie et al., 2005). For example, Mays and colleagues (2005, p. 7) offer:



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