CHL 630 Week 3 Intervention Activity Design Example

Twenty-Two Sessions, Three Evening Walks a Week and Four Stores: Designing the Activities of Walk and Eat Well in Detail

[Student Name]

University of Phoenix

CHL/630: Planning and Implementing Community Health Initiatives

Week 3 Assignment

[Instructor Name]

[Date]

The initiative's sessions, schedules, stores, staffing and adaptations are composites written for a model paper modeled on Yakima, Washington; research findings come from the sources cited.

During training for the new Walk and Eat Well promotoras, one of them asked the coordinator a simple question: what exactly happens in session five? The coordinator realized the plan described components but not activities. This paper designs each activity at the level of detail a promotora, a walk leader or a grocer needs.

Lifestyle Groups: Structure and Dose

The lifestyle groups follow a year-long structure: 16 weekly core sessions over four months, then 6 monthly maintenance sessions, 22 in all. Each session lasts 60 minutes. Groups of 12 to 15 adults meet at a church hall or the community center, in Spanish or English, on weekday evenings or Saturday mornings, with child care.

Session Outline: Phase One, Getting Started

Sessions one to four cover setting a personal weight goal of about 5% and an activity goal of 150 minutes a week, learning to track food and steps with a picture log or phone app, identifying one small change for the week and weighing in privately.

Phase Two: Eating Well

Sessions five to eight focus on food. Session five, the promotora's question, is a cooking demonstration: modifying a family favorite, such as enchiladas, with less oil, leaner meat and more vegetables, followed by tasting and discussion of how to introduce the change at home.

Phase Three: Moving More

Sessions nine to twelve focus on activity: walking with the group on the river path, chair exercises for those with joint pain, fitting movement into long work days and setting step goals.

Phase Four: Staying on Track

Sessions thirteen to sixteen address stress, sleep, family support, handling setbacks and planning for holidays and harvest season. Monthly maintenance sessions review goals and celebrate progress.

Evidence for Promotora Delivery

Peer delivery has trial support. Project Dulce randomized 207 adults from San Diego community health centers, most born in Mexico and many with little schooling, to peer-led classes or usual care. Those taught by trained peers saw A1c fall sharply, by well over a point at both four and ten months, along with gains in cholesterol and diastolic pressure; usual care produced no comparable change (Philis-Tsimikas et al., 2011).

Evidence on Educators and Attendance

Real-world diabetes prevention programs point the same way. Pooling 28 community adaptations of the national trial, Ali and colleagues saw no meaningful difference in year-one weight loss between groups run by lay leaders and groups run by clinicians, and they found that results climbed with attendance, by roughly a quarter point of weight lost for every extra session (Ali et al., 2012). Every session a participant attends adds to the result, which makes keeping people in the group a design task in its own right.

Walking Groups: Protocol

Walking groups meet on the lit river path on Monday, Wednesday and Friday at 7:30 p.m., after the evening bus arrives, and on Saturday at 8 a.m. Each walk has a trained volunteer leader, starts with stretching, offers a two-mile and a one-mile loop and ends with a short conversation. Walk leaders carry a first aid kit and a phone and track attendance.

Walking Groups: Prompts and Promotion

Bilingual signs at path entrances show distances and minutes walked. Churches announce walks after services, the Spanish radio station broadcasts the schedule and lifestyle group participants are invited in session nine.

Evidence for Walking Groups

The Guide to Community Preventive Services found that social support interventions in community settings, and better access to places for exercise when paired with outreach, both raised activity levels (Kahn et al., 2002). The walking groups combine both.

Store Program: Steps

The store program proceeds in five steps. First, the coordinator meets owners to learn what sells and what barriers they face. Second, each store receives a grant of up to $3,000 for a refrigerated produce case and shelving. Third, the coordinator links stores with a regional produce distributor for smaller, fresher deliveries. Fourth, bilingual shelf labels mark healthier choices, and produce moves near the register. Fifth, monthly tastings let shoppers try recipes from the lifestyle groups.

Evidence for the Store Program

A review of 16 small-store trials found common strategies included stocking healthier foods, point-of-purchase promotion and community engagement, and those trials measurably raised both the stock of healthy items and their sales, while shoppers' knowledge and eating habits improved (Gittelsohn et al., 2012).

Training the Team

Promotoras complete 30 hours of training in the curriculum, group facilitation, motivational conversations, weighing and recording data and privacy. Walk leaders complete a four-hour session on safety, route management and encouragement. Grocers attend a two-hour orientation on produce handling, pricing and displays. Refresher trainings occur every six months, and promotoras observe one another's sessions to share techniques.

Recruitment

Lifestyle group participants are recruited through clinic referrals, community health workers, screening at the flea market and church announcements. Walking groups are open to all. Store shoppers are reached through tastings and radio.

Retention

Retention strategies include text reminders, phone make-up sessions for missed classes, a buddy system, small incentives such as a pedometer at session four and a kitchen scale at session eight and recognition at a graduation celebration.

Safety and Accessibility

Walks follow lit routes and never split the group without a second leader. Sessions are held in accessible buildings, and chair options are offered for people with arthritis or balance problems. Participants with diabetes symptoms or high blood pressure readings at weigh-ins are referred to the clinic the same week, with the community health worker program helping them get an appointment.

Adaptations and Core Elements

Adaptations include Spanish-language groups, familiar foods, family members welcome, evening and weekend schedules and chair exercises. Core elements that will not change are the weight and activity goals, self-monitoring, the number of core sessions and weigh-ins.

Materials

Materials are simple and bilingual: picture-based food and step logs, a participant binder with large print, portion plates, recipe cards from participants' kitchens, a scale for private weigh-ins, pedometers and route maps for the river path. Stores receive shelf labels, a produce display guide and tasting supplies. All materials were reviewed by the resident advisory group before printing.

Links Among Components

Lifestyle participants walk with the groups in phase three and taste store recipes in phase two. On Saturdays the walkers finish their route at one of the partner grocers, which in turn display the walking schedule. Each component recruits for the others.

First-Year Calendar

Months one and two: train promotoras and walk leaders, recruit stores. Month three: launch first four lifestyle groups and walking groups; install store cases. Months four to twelve: add groups every two months, run monthly tastings and hold a community walk each season.

Conclusion

Walk and Eat Well now has activities a promotora, walk leader or grocer can carry out: a 22-session lifestyle curriculum, a walking protocol on the lit path and a five-step store program. Trial and meta-analytic evidence supports peer delivery and attention to attendance, and reviews support the walking and store designs. Adaptations fit the community while core elements stay intact.

References

Ali, M. K., Echouffo-Tcheugui, J. B., & Williamson, D. F. (2012). How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Affairs, 31(1), 67-75. https://doi.org/10.1377/hlthaff.2011.1009

Gittelsohn, J., Rowan, M., & Gadhoke, P. (2012). Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease. Preventing Chronic Disease, 9, Article E59. https://doi.org/10.5888/pcd9.110015

Kahn, E. B., Ramsey, L. T., Brownson, R. C., Heath, G. W., Howze, E. H., Powell, K. E., Stone, E. J., Rajab, M. W., & Corso, P. (2002). The effectiveness of interventions to increase physical activity: A systematic review. American Journal of Preventive Medicine, 22(4 Suppl.), 73-107. https://doi.org/10.1016/S0749-3797(02)00434-8

Philis-Tsimikas, A., Fortmann, A., Lleva-Ocana, L., Walker, C., & Gallo, L. C. (2011). Peer-led diabetes education programs in high-risk Mexican Americans improve glycemic control compared with standard approaches: A Project Dulce promotora randomized trial. Diabetes Care, 34(9), 1926-1931. https://doi.org/10.2337/dc10-2081