Curran Sarah, Gittelsohn Joel, Anliker Jean, Ethelbah Becky, Blake Kelly, Sharma Sangita, Caballero Benjamin
Center for Human Nutrition, Johns Hopkins University, Bloomberg School of Public Health, Cambridge, MA 02138, USA.
Health Educ Res. 2005 Dec;20(6):719-29. doi: 10.1093/her/cyh032. Epub 2005 May 4.
Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.
肥胖及其他与饮食相关的慢性病在美国印第安社区广泛存在。许多保留地难以获取健康食品，导致了高脂肪、高糖的饮食习惯。本文旨在报告一项基于食品店的项目在两个美国印第安保留地改善饮食的过程评估结果。从11家干预商店收集过程数据，以记录阿帕奇健康商店（AHS）项目的实施情况。过程评估工具记录了推广食品的库存、店内宣传材料的情况、烹饪示范和口味测试的实施及参与情况，以及大众媒体信息的传播。在商店层面，该项目以高剂量和高覆盖水平实施，保真度为中到高水平。在社区层面，AHS项目以中等保真度和剂量实施。在个人层面，烹饪示范和口味测试以高剂量覆盖了大量社区成员。在多个层面（商店、社区、个人）实施AHS项目具有挑战性，且各层面情况不同。总体而言，随着项目工作人员对实施障碍进行监测、记录并做出应对，从始至终都有改进。过程数据将与结果相关联，对未来基于商店的项目规划将很有用。
