Health Education Research Advance Access first published online on July 16, 2007
This version published online on July 26, 2007
Health Education Research, doi:10.1093/her/cym031
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Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations
1 Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA
2 Centre For Studies in Family Medicine, University of Western Ontario, 245-1 00 Collip Circle, London, Ontario, Canada N6G 4X8
3 Cancer Etiology Program, Cancer Research Center of Hawaii, University of Hawaii, 1236 Lauhala Street, Honolulu, HI 96813, USA
Correspondence to: * Correspondence to: A. M. Rosecrans. E-mail: arosecra{at}jhsph.edu
Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.
This is a new version of this article as the first version had a small error in the title.
Received on November 20, 2006; accepted on May 10, 2007
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  L. S. Ho, J. Gittelsohn, R. Rimal, M. S. Treuth, S. Sharma, A. Rosecrans, and S. B. Harris An Integrated Multi-Institutional Diabetes Prevention Program Improves Knowledge and Healthy Food Acquisition in Northwestern Ontario First Nations Health Educ Behav, August 1, 2008; 35(4): 561 - 573. [Abstract] [PDF]
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