Using the Community Readiness Model to Select Communities for a Community-Wide Obesity Prevention Intervention

Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA.
Preventing chronic disease (Impact Factor: 2.12). 11/2011; 8(6):A150.
Source: PubMed


To build on a growing interest in community-based obesity prevention programs, methods are needed for matching intervention strategies to local needs and assets. We used the Community Readiness Model (CRM), a structured interview guide and scoring system, to assess community readiness to act on childhood obesity prevention, furthering a replication study of a successful intervention.
Using the CRM protocol, we conducted interviews with 4 stakeholders in each of 10 communities of similar size, socioeconomic status, and perceived readiness to implement a community-wide obesity prevention intervention. Communities were in California, Florida, Illinois, Massachusetts, New York, North Carolina, Pennsylvania, and Tennessee. The 4 stakeholders were the mayor or city manager, the school superintendent, the school food service director, and a community coalition representative. Interviews were recorded and professionally transcribed. Pairs of trained reviewers scored the transcriptions according to CRM protocol. The CRM assesses 9 stages of readiness for 6 dimensions: existing community efforts to prevent childhood obesity, community knowledge about the efforts, leadership, community climate, knowledge about the issue, and resources. We calculated an overall readiness score for each community from the dimension scores.
Overall readiness scores ranged from 2.97 to 5.36 on the 9-point scale. The mean readiness score, 4.28 (SD, 0.68), corresponds with a "preplanning" level of readiness. Of the 6 dimensions, community climate varied the least (mean score, 3.11; SD, 0.64); leadership varied the most (mean score, 4.79; SD, 1.13).
The CRM quantified a subjective concept, allowing for comparison among 10 communities. Dimension scores and qualitative data from interviews helped in the selection of 6 communities for a replication study.

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    • "As the CRM is an iterative tool, communities are also encouraged to conduct multiple assessments over time to help the community identify successes and determine whether any new barriers have emerged as a result of the changes made (Oetting et al. 1995). A community readiness lens has been applied to various health programs, including tobacco cessation programs (York et al. 2008), HIV prevention interventions (Aboud et al. 2010), and obesity prevention programs (Findholt 2007; Sliwa et al. 2011). However , it has not been used specifically to examine readiness for a water management intervention, specifically in terms of WSPs at the municipal level. "
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    ABSTRACT: A safe supply of drinking water is a cornerstone of public health and community well-being. Complacency among those responsible for the provision of safe drinking water (e. g., water suppliers, operators, and managers) has led to numerous and otherwise avoidable waterborne outbreaks. Water safety plans present a risk-based, proactive framework for water management, and when properly implemented, virtually eliminates the option for complacency. However, the uptake of water safety plans remain limited worldwide. This paper reports on the experiences of early water safety plan adopters and identifies a number of non-technical operational and human factors that have undermined previous efforts. Specifically, it identifies these factors as a gap in the water safety plan implementation literature and suggests incorporating the broader community in water safety planning through a community readiness approach. Assessing and building community readiness for water safety plans is suggested to be a critical pre-implementation step, and a potential tool for use by water suppliers and by policy makers.
    Environmental Reviews 07/2014; 23(1):1-6. DOI:10.1139/er-2014-0030 · 3.00 Impact Factor
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    • "The CRM has been applied to childhood overweight and obesity prevention previously in America and Australia to do the following: calculate a pre-intervention readiness score and implement strategies to prevent overweight and obesity in childhood [19]; identify a community with a readiness score high enough to implement a community-based obesity prevention intervention in 6–9 year olds through a competitive process; [20] and assess readiness pre and post a community-based obesity prevention intervention conducted with 12–18 year olds [21]. The latter found that intervention schools increased their readiness, whilst control schools did not, and those intervention schools with the greatest increases had the greatest decreases in the prevalence of overweight and obesity [21]. "
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    ABSTRACT: Childhood overweight and obesity is a global public health concern. For girls in particular, being overweight or obese during pre-adolescence (aged 7-11 years) has intergenerational implications for both the mother and her future offspring. In the United Kingdom (UK) there is increasing interest in community targeted interventions but less is known about how to tailor these approaches to the needs of the community. This study applied the Community Readiness Model (CRM), for the first time in the UK, to demonstrate its applicability in designing tailored interventions. Community readiness assessment was conducted using semi-structured key informant interviews. The community's key informants were identified through focus groups with pre-adolescent girls. The interviews addressed the community's efforts; community knowledge of the efforts; leadership; community climate; community knowledge of the issue and resources available to support the issue. Interviews were conducted until the point of theoretical saturation and questions were asked separately regarding physical activity (PA) and healthy eating and drinking (HED) behaviours. The interviews were transcribed verbatim and were firstly analysed thematically and then scored using the assessment guidelines produced by the CRM authors. Readiness in this community was higher for PA than for HED behaviours. The lowest scores related to the community's'resources' and the'community knowledge of the issue'; affirming these two issues as the most appropriate initial targets for intervention. In terms of resources, there is also a need for resources to support the development of HED efforts beyond the school. Investment in greater physical education training for primary school teachers was also identified as an intervention priority. To address the community's knowledge of the issue', raising the awareness of the prevalence of pre-adolescent girls' health behaviours is a priority at the local community level. Inconsistent school approaches contributed to tensions between schools and parents regarding school food policies. This study has identified the readiness level within a UK community to address the behaviours related to overweight and obesity prevention in pre-adolescent girls. The focus of an intervention in this community should initially be resources and raising awareness of the issue within the community.
    BMC Public Health 12/2013; 13(1):1205. DOI:10.1186/1471-2458-13-1205 · 2.26 Impact Factor
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    • "Findholt and colleagues reported a score of one when assessing Union County's readiness to intervene in childhood obesity suggesting that the community had no awareness of childhood obesity as a problem (Findholt, 2007). Sliwa et al. (2011) used RTC scores to select communities for an obesity prevention intervention. The average RTC score of these communities was four, positioning them in the preplanning stage. "
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    ABSTRACT: Background: Community capacity building is a promising approach in reducing childhood obesity. The objective was to determine changes in capacity over a 3 year intervention (2005-2008) in schools and whether greater increases in capacity were associated with greater decreases in overweight/obesity. Methods: "It's your Move!" (IYM) was an obesity prevention project, in 12 Australian secondary schools (5 intervention; 7 comparison), that aimed to increase community capacity to promote healthy eating and physical activity. Capacity was assessed pre/post intervention using the 'Community Readiness to Change (RTC)' tool. Comparisons from baseline to follow-up were tested using Wilcoxon Signed-Ranks and results plotted against changes (Newcombe's paired differences) in prevalence of overweight/obesity (WHO standards). Results: RTC increased in intervention schools (p=0.04) over time but not for comparison schools (p=0.50). The intervention group improved on 5 of 6 dimensions and the three intervention schools that increased three levels on the RTC scale each had significant reductions in overweight/obesity prevalence. Conclusion: There were marked increases in capacity in the intervention schools and those with greater increases had greater decreases in the prevalence of overweight/obesity. Community-based obesity prevention efforts should specifically target increasing community capacity as a proximal indicator of success.
    Preventive Medicine 02/2013; 56(6). DOI:10.1016/j.ypmed.2013.02.020 · 3.09 Impact Factor
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