Best Prac*ces and Innova*ve Solu*ons to Overcome Barriers to Delivering Policy,

Systems and Environmental Changes in Rural Communi*es

LindseyHaynes-Maslow,MHA StephanieJilco8Pi8s,PhD AssistantProfessor&ExtensionSpecialist Professor DepartmentofAgricultural&HumanSciences DepartmentofPublicHealth NCSateUniversity EastCarolinaUniversity Lhaynes-maslow@ncsu.edu jilco8s@ecu.edu

Study Purposes

• TounderstandbarrierstoimplemenLngSNAP-EdprogramminginruralcommuniLes.

• ToidenLfystrategiesthatSNAP-EdimplemenLngagencies(IAs)andstaffhaveemployedinruralcommuniLestoovercomePSEandtradiLonalprogrammingbarriers.

Why Focus on Rural Communi*es? Why SNAP-Ed?

• WhyFocusonRural?:Individualslivinginruralareasaremorelikelytobeobeseandeatfewerfruitsandvegetablesthanthoselivinginurbanareas.

• WhySNAP-Ed?:SNAP-EdisafederallyfundednutriLoneducaLonprogramthatisavailableinmanyareasofmoststates,andisaresourceforruralareas.

•  However,recruiLngparLcipantstoa8endSNAP-Edclassescanbechallenginginruralareas,duetotransportaLon,Lme,andlackofconvenience.

Methods

“Rural”

“Urban"

Defining“Rural”

Source:USDA,EconomicResearchServiceusingU.S.CensusBureauData

Study Methods

• Mixedmethodsapproach(quanLtaLveandqualitaLvedata)•  RecruitedstaffatSNAP-EdprogramstocompleteonlinesurveybyusingtheNutriLonandObesityPolicyResearchandEvaluaLonNetworksandAssociaLonforSNAPEducaLonNutriLonAdministraLonlistservs

•  SurveyrespondentshadtheopportunitytovolunteertoparLcipateinterviewsifthey:1.  WereaSNAP-EdstaffmemberthatpersonallyengagedinimplemenLngprograms

inthecommunity2.  WorkedforSNAP-Edprogramthatprovidesatleast50%oftheirprogrammingin

ruralcommuniLes3.  Workedintheirroleforatleast12months

Survey & Interview Ques*ons Surveys

•  RatelevelofknowledgewithPSEapproachestobehaviorchange

•  RatelevelofexperiencewithPSEapproachestobehaviorchange

•  ListtypesofcommunityseangswherePSEwasimplemented

•  ListwhattypesofpartnershelpedtoimplementPSE

Interviews•  DescribegeneralexperiencewithSNAP-Ed

•  DescribedifferenttypesofSNAP-Edprogrammingcurrentlybeingimplemented

•  TypesofPSEiniLaLvesinvolvedwith•  BarrierstoimplemenLngSNAP-Edprogramming

•  FacilitatorstoimplemenLngSNAP-Edprogramming

•  MajorissuesruralcommuniLesfacerelatedtoopportuniLesforeaLnghealthyandphysicalacLvity

Analysis

•  ForquanLtaLvesurveys,descripLvestaLsLcswerecalculatedtodeterminefrequenciesofvariousresponses.

•  QualitaLveinterviewsweretranscribedverbaLmandanalyzedusingAtlas.Lversion7.0.

•  Createdacodebookfrom2codersindependentlycodingasubsetofthreeinterviews.

•  Twocodersthenindependentlyappliedcodestoallinterviewtranscripts.•  FinalthemeswerecompiledbasedonquesLonsincludedontheinterviewguide.

•  “InnovaLvepracLces”werePSEstrategiesthatweremenLonedbyonly1respondent,and“bestpracLces”werethosestrategiesmenLonedbymorethanonerespondent.

Results

Survey Results (N=35) •  85%wereknowledgeable/veryknowledgeableaboutPSE•  60%wereexperienced/veryexperiencedwithimplemenLngPSE

SETTTING PARTNERIworkinthis

se@ngHealth

DepartmentsRetailfoodstoreowners/managers

Foodpolicycouncils

Worksitestaff Other

Childcarecenter 61% 11% 0% 4% 30% 18%School 96% 7% 5% 11% 50% 23%Workplace 64% 12% 2% 9% 19% 22%SeniorCenter 68% 15% 0% 7% 22% 25%Faith-basedlocaLons 66% 5% 2% 12% 20% 27%Cornerstore 54% 11% 22% 3% 6% 12%Grocerystore 53% 7% 26% 2% 4% 14%Supermarket/supercenter 24% 2% 10% 2% 4% 6%FoodPantry 89% 15% 4% 17% 27% 27%Farmer'sMarket 83% 13% 3% 13% 22% 32%OtherSe@ng 44% 2% 0% 2% 12% 18%

Interviews with SNAP-Ed Staff

NERO(1)MRPO(3)

MWRO(7)

SERO(8)

WRO(3)

SERO(3)

MARO(2)

Interview Par*cipant (n = 27) Demographics CharacterisLc PercentNumberofyearsworkingforSNAP-Ed0-2 40.7% 3-5 22.2%6-10 11.1%>10 18.5%Age(average) 39GenderMale 7.4%Female 81.5%Race/EthnicityWhite 70.0%NaLveAmerican/AmericanIndian 3.7%HispanicorLaLno 7.4%AfricanAmericanorBlack 7.4%

CharacterisLc PercentWorkConductedinRuralCommuniLes25-50% 18.5%51-75% 14.8%> 75% 94.1%PSEWork< 25% 22.2%25-50% 18.5%51-75% 14.8%> 75% 37.0%Direct-EdWork< 25% 51.9%25-50% 14.8%51-75% 14.8%> 75% 11.1%

Overall Results

• ThemostcommonPSEiniLaLvesmenLonedweregardens,schoolwellness-basediniLaLves,healthyfoodretail,farmers’markets,andfoodpantries.

• Challengeswerefunding,andlevelofPSEunderstandingamongSNAP-Edstaffandstakeholders.

• Strategiestoovercomethesechallengesincludedworkingthroughpartnershipsandfindingshort-termPSEwinstodemonstratetheimportanceofthisapproachtobehavioralchange.

Gardens • Basicgardeningskills,beekeepingandcomposLng•  Seang-specificbarriers:

• Weather•  CompeLngforLmewithschools’curriculumstandards.

• BestpracLces:Encouragingallschoolstohaveagarden(makingittheculturalnorm)andsupportfromthecommunity.

•  InnovaLvesoluLons:WorkmeeLngsinthegardentoraiseawareness.

•  “OureducatorpartneredwithExtensionandtheyhelpedtellher(worksiteowner)whatkindofplantsgrowwellthereandtaughtheraboutcompanionplants…AndshepartneredwithotheragenciessotheycouldhaveworkingmeeIngsandactuallyworkinthegardenwhiletheywerediscussingbusiness.”

School Wellness • Smarterlunchrooms,farm-to-schoolprojects,schoolgardens,andtastetasLngs.

• Barriers:CompeLngforclassLmeandlackofbuy-infromschoolprincipalsorteachers.

• BestpracLces:CreatedprogramsthatdidnotrequireteacherparLcipaLonandaskschoolleadershiptochoosewhichPSEiniLaLve(s)theywantedtoimplement.

• InnovaLvesoluLons:Convertedanoldandoutdatedpoolintoagardenandconvertedthepoolhouseforproduceprocessing,andtoolandlumberstorage.

Healthy Food Retail

• Newsignagetodirectpeopletowardshealthierfooditems,adsforhealthyfoodspecials,andcreaLnghealthyfoodcheck-outlines.

• Barriers:Lackofbuy-infromstoreowners,difficultymeasuringimpact,ensuringsignageandinventoryconLnued.

• BestpracLces:RegularcommunicaLonwithownerstohighlighthowsmall,noorlowcostchangescouldimprovethecommunity’sdietandhealth.

•  InnovaLvesoluLons:Encouragedbundlinghealthyfoodswithhighdemandfoodsandworkingwithanindependentgrocerystoreownertodevelopamobilegrocerystoretoincreaseaccesstohealthyfoodinareaswithlimitedaccess.

Farmers’ Markets •  Encouragingfarmer’smarketstoacceptSNAP/EBT,foodtasLngsandcookingdemonstraLons,hand-outswithrecipesorhealthLps.

• Barriers:SomecommuniLesdidnothavefarmer’smarkets,soSNAP-Edstaffworkedontryingtocreateone.

• BestpracLces:PartneringwithotherorganizaLonstoimplementincenLveprograms.

•  InnovaLvesoluLons:•  “OneofthePSEchangesthatwedidputinplaceatourfarmer’smarketwasdemonstraLnghealthyrecipesuLlizingsomeofthefruitsandvegetablesthatwerebeingfeaturedtherethatweek,soanybodythatcameinanddidafooddemonstraLonhadtoservefruitsandvegetables…Waterisservedasthebeverageofchoicethere,whereasbeforetheymayhavebeendoingpunch…”

Food Pantries

• Nudgingcustomerstowardshealthierfoodsandusingtheclientchoicemodel.

• Barriers:Lackofbuy-infromfoodpantryowners—astheydidnotwanttochangefooddistribuLonspolicy.

• BestpracLces:WorkingwithfoodpantryownersandmanagersandmovingtowardsprovidinghealthierfoodopLons.

• InnovaLvesoluLons:Partneringwithamedium-securityprisonontheirproduce-growingcontest—prisonstrytogrowthemostproduceandaqerthecontest,theproduceisdonatedacrossthecommunity.

Barriers: Funding

•  LackoffundingfortheamountofprogrammaLcworkthatneedstobedone

•  LackofabilitytocoverincenLvesforparLcipantsand/orpartners

“Thebiggestbarrierisfundingbecauselotofpeoplelikethese[PSE]ideas,butthere’sveryliPleextramoneylayingaround.”

Barriers: Level of PSE Understanding

•  SNAP-EdstaffandstakeholdershavealackofunderstandingPSEandwhyit’simportant

“EventhoughI’mcomfortablewithPSE,manyofourSNAP-Edassistantsarenot.‘Policy’isascarywordtothemandIthinkatrainingtomakethemfeelmorecomfortableaboutit,andrealizethatit’snotalwaysabouttalkingtosenators,wouldbehelpful.”

Facilitators: Partnerships

• PartneringwithothercommunityiniLaLvesororganizaLons,buildingrelaLonshipswithcoaliLons,wellnesscommi8ees,andadvisorygroups,canhelpwithimplemenLngSNAP-Edprogramming

“Oneoftheadvantagesofbeinginaruralplaceiseverybodyknowseachother,sotheyhavetheabilitytonetworkandbuildorenhancepartnerships.”

Facilitators: Short-term PSE Wins

•  RecognizingtheimportanceofhavingshorttermwinstoprovethatPSEcanbeaneffecLvestrategyforbehaviorchange,thisincludesbeingintenLonalwhereyouwork–choosinglocaLonswhereyouthinkyourprogrammingwillbesuccessful.

“Ithinkareallyhelpfulstrategyistofindawaytoplugintothingsthatarealreadysortof“easywins”thatarealreadystarIngoriniIatedandthentryingtohelpshapeanddirectthemtothemorehealthydirecIon.”

Conclusions

Conclusions

•  SNAP-EdPSEiniLaLvesinruralareasincludedworkingwithschools,gardens,foodpantries,farmers’markets,andfoodretailseangslikecornerstoresandsupermarkets.

• PartnershipsanddemonstraLngshort-termPSEwinswereimportanttoovercomingbarriers.

•  Strengths:Geographicvariability(SNAP-EdstafffromallsevenSNAP-Edregions)andtrainedqualitaLveresearchersconductallinterviews,double-codetranscripts,andreconcileallcodes.

•  LimitaLons:PotenLalselecLonbiasforthosewhochosetoparLcipateintheinterviews.

Thank You to Our Funders!

•  ThisresearchwassupportedbyagrantfromHealthyEaLngResearch,anaLonalprogramoftheRobertWoodJohnsonFoundaLonandtheNutriLonandObesityPolicyResearchandEvaluaLonNetwork.

•  TheviewsexpressedheredonotnecessarilyreflecttheviewsofHealthyEaLngResearchoroftheFoundaLon.

•  ThispaperwaspublishedinNutrients:•  Abstract:h8p://www.mdpi.com/2072-6643/10/8/1012•  HTMLVersion:h8p://www.mdpi.com/2072-6643/10/8/1012/htm•  PDFVersion:h8p://www.mdpi.com/2072-6643/10/8/1012/pdf

Ques*ons?

Ideasforajoint/cross-siteresearchproject:1. Examininghealthyfoodserviceguidelinesinruralhospitals.

2. ExaminingdistribuLonchainsforsmallfoodstoresa8empLngtostock/promotehealthierfoods.

3. Other?