Submitted to: Progress in Community Health Partnerships: Research, Education and Action
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/22/2006
Publication Date: 3/31/2007
Citation: Zoellner, J., Connell, C., Santell, R., Fungwe, T., Strickland, E., Avis, A., Yadrick, K., Lofton, K., Rowser, M., Powers, A., Lucas, G., Bogle, M.L. 2007. Fit for Life Steps: Results of a successful walking trail intervention in the rural Mississippi Delta. Progress in Community Health Partnerships: Research, Education and Action. 1(1):49-60. Interpretive Summary: Community members, university partners, and ARS collaborated to plan, implement, and evaluate a walking program as a research intervention in a small, rural community in the Delta region of Mississippi. Interventions that focus on lifestyle factors that affect health are important in this area, which is plagued by rates of obesity, diabetes, high blood pressure, and heart disease that are among the highest in the U.S. The unique feature of the walking intervention is that it was developed and carried out using community based participatory research (CBPR). CBPR builds on the strengths of all the collaborators to design programs that benefit from the wisdom and experience of all involved, rather than using the traditional approach in which academic partners are in control of the research process. Community members actively participated in assessing the problem, identifying the intervention, intervention planning, data collection, and evaluation. They identified lack of physical activity as a key nutrition and health problem in their community, and identified potential causes including lack of role models in the community, lack of will power and self esteem, and lack of physical activity education and trainers. A walking intervention program was planned by all the collaborators, which included installing a walking trail and training community volunteers to teach and promote physical activity. The 6-month walking intervention focused on improving physical activity and health through walking teams led by supportive volunteer "coaches," self-monitoring, and monthly nutrition and physical activity educational sessions. Sixty-three community members completed the walking intervention. They experienced significant improvements in waist circumference, systolic blood pressure, and HDL cholesterol during their participation. The process of developing and implementing this CBPR walking intervention in this community was considered successful because of the community's active contribution and participation in each phase of this research, the undertaking and application of basic research components in a setting that presents challenges for the research process, significant improvements in several health measures of participants, and the sustainability of partnerships formed through this intervention.
Technical Abstract: A collaborative community-university partnership developed and implemented a 6-month walking trail intervention whereby volunteer coaches were trained to lead community walking groups. This quaisi-experimental design examined the feasibility of implementing community-based participatory research in a medically-underserved rural Mississippi Delta community. Changes in BMI, %body fat, waist circumference, blood pressure, blood glucose, lipid profile, self-reported walking, stages of change, social support, self-efficacy, and decisional balance were examined at enrollment, 3 months and 6 months. Participants were primarily African American (98.5%) women (97%). Of the 83 enrolled participants, 66 (80%) completed the intervention. Statistical analysis: Changes were evaluated using repeated measures ANOVA. Community members actively participated in assessing the problem, identifying the intervention, intervention planning, data collection, and evaluation. Participants exhibited significant improvements in waist circumference (-1.45 inches), systolic blood pressure (-4.32 mmHg), and HDL cholesterol (+7.89 mg/dL) (p<.001). Self-reported minutes walking per day was 44.84 (SD+52.20) at enrollment, 76.60 (SD=166.61) at 3 months, and 65.90 (SD+89.73) at 6 months (p+.153). A positive stage of change shift occurred in 57% of participants; however no significant positive changes occurred in the other psychosocial variables. The process of developing and implementing this CBPR walking trail intervention in this underserved community was considered successful as evidenced by the community's active contribution and participation in each phase of this research, the undertaking and application of basic research components, significant improvements in several anthropometric and biological values, and the sustainability of the partnerships formed through this intervention.