Participatory Policy Study in a Northern New Mexico Community New Mexico Healthier Weight Council Quarterly Meeting March 31, 2011 1.

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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Yolanda [email protected]

Ron [email protected]

Victoria [email protected]

Perdita [email protected]

Contacts

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