Mississippi communities for healthy living: implementing a nutrition intervention effectiveness study in a rural health disparate region

Authors: CONNELL, CAROL - University Of Southern Mississippi; Thomson, Jessica; HUYE, HOLLY - University Of Southern Mississippi; LANDRY, ALICIA - University Of Southern Mississippi; CROOK, LASHAUNDREA - University Of Southern Mississippi; YADRICK, KATHY - University Of Southern Mississippi

Submitted to: Contemporary Clinical Trials
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/2/2015
Publication Date: 4/22/2015
Publication URL: http://handle.nal.usda.gov/10113/61975
Citation: Connell, C.L., Thomson, J.L., Huye, H.F., Landry, A.S., Crook, L.B., Yadrick, K. 2015. Mississippi Communities for Healthy Living: implementing a nutrition intervention effectiveness study in a rural health disparate region. Contemporary Clinical Trials. 42:196-203.

Interpretive Summary: Diet related chronic diseases, such as obesity, type 2 diabetes, and heart disease, plague rural populations, like the Lower Mississippi Delta, with greater prevalence than the nation as a whole. Compounding the health inequities found in this region of the country are the difficulties facing researchers who seek to intervene with such populations. Challenges include designing and implementing culturally appropriate and acceptable interventions, recruitment and retention, and data collection. With these challenges in mind, the design and implementation of the Mississippi Communities for Healthy Living (MCHL) Study incorporated previous dietary knowledge and recruitment experiences with Lower Mississippi Delta populations as well as methods grounded in social and behavioral theory. Women’s organizations and churches in the Lower Mississippi Delta were recruited for this dietary intervention with cluster stratified random assignment to one of two treatment arms – single message or multiple messages. Data were collected at 3 time points – enrollment (prior to treatment arm assignment), baseline (after treatment arm assignment but prior to intervention), and at 6 months follow-up (post intervention). The majority of participants in both treatment arms were female, African American, not married, and obese; and had at least a high school education. Mean diet quality scores were generally low for both treatment arms. At enrollment, participants in the two treatment arms did not differ on demographic, anthropometric, or clinical measures. Additionally, comparisons of dietary intake between enrollment and baseline suggested that participants had not improved their diet quality simply from enrolling in and thus becoming aware of the purpose of the study (i.e., the Hawthorne effect). Future analyses will determine if Mississippi Communities for Healthy Living was effective at improving diet quality in this cohort of Southern, primarily African American adults.

Technical Abstract: Intervention research in rural, health disparate communities presents unique challenges for study design, implementation, and evaluation. Challenges include: 1) culturally appropriate intervention components; 2) participant recruitment and retention; 3) treatment cross-contamination; 4) intervention delivery and data collection; and 5) potential measurement reactivity. The intent of Mississippi Communities for Healthy Living (MCHL) study was to test the effectiveness of an intervention promoting adoption of culturally relevant Dietary Guidelines for Americans components on diet quality. MCHL was developed using the RE-AIM planning and evaluation framework (reach, effectiveness, adoption, implementation, maintenance). Intervention components were based on Roger’s diffusion of innovation attributes that promote adoption of a new innovation as well as on the psychosocial constructs of social support, self-efficacy and decisional balance. Participant outcomes included diet quality, blood pressure, weight status, and quality of life. Rolling enrollment was used to acquire sufficient sample size and to assess measurement reactivity effects prior to the 6-month intervention. Cluster stratified assignment to one of two treatment arms was utilized to minimize cross contamination between treatment arms. Trained nutrition educators delivered nutrition education sessions which were followed up by focused newsletters and encouragement contacts from group champions. The primary aims of this paper are to: 1) detail the methods of the MCHL study; and 2) report baseline demographic characteristics of study participants. The secondary aim is to determine if study participants were engaging in behavior changes after enrollment and prior to intervention initiation.