Native American Youth Cardiovascular Disease Prevention: Implementation of Culturally-Tailored Evidence-Based After School and Home Visitation Programs for Healthy Eating and Physical Activity

PROJECT SUMMARY – Project 3 Urban Native American communities experience significant and persistent disparities in cardiovascular diseases, obesity and diabetes, and their preventable behavioral precursors, diet and physical activity. This study implements two multi-level evidence-based interventions (EBIs) Minnesota NET-Works and Stanford GOALS in partnership with six American Indian after school programs and community-serving organizations in the Minneapolis, St Paul and Duluth Minnesota. Adoption and maintenance of these programs can be enhanced and effectiveness strengthened through a structured, evidence-based participatory approach that tailors the interventions to meet the cultural, organizational contextual, and broader socioeconomic context and incorporates local innovations. This proposal is poised to achieve these goals through a community-based participatory research (CBPR).Coalition including the healthcare provider Minneapolis Native American Community Clinic (NACC, primary care system), Minneapolis and St Paul and Duluth Minnesota School Districts' Indian Education after school programs (school system), the social service provider Division of Indian Work's Family Spirit Home Visitation program (social service provider system), departments of public health and University of Minnesota researchers. The Coalition will use the evidence-based 10-step Getting to Outcomes (GTO) tailoring and implementation approach to enhance implementation fidelity, reach and acceptance, and sustainability among the after school programs and community-serving organizations. Native American organization leadership and program delivery staff will receive mentoring and training in the tailored EBI curricula and in effective implementation strategies. Implementation strategy effectiveness will be assessed using a stepped wedge study design. The study uses the Social Ecological Model as its multilevel intervention framework, and RE-AIM as its implementation process evaluation measurement framework. Implementation outcomes include organizational leadership support, staff implementation capacity, and intervention fidelity (program reach, intervention content, delivery, receipt and dose). An important innovative aspect of the proposed research is its use of evidence-based implementation strategies to strengthen the capacity of the programs and staff to implement the interventions with broad reach, high participation, and strong fidelity by aligning with local culture and context. The proposed project will use proven effective implementation strategies to build program organizational leadership and program delivery staff implementation capacity to successfully engage urban Native American families in strengths-based, culturally- grounded programs to promote youth physical activity and healthy eating. Sustained program engagement among urban Native American families will promote healthy eating and physical activity behaviors that will reduce future cardiovascular disease risk in this highly burdened community.