Reach Through Equitable Implementation: Turtle Island Tales

Project Leader Emily Tomayko, Ph.D.
MSU Department of Food Systems, Nutrition & Kinesiology
EmilyTomayko@montana.edu 

American Indian (AI) communities experience profound health and economic inequities across the lifespan, including increased risk for obesity, cancer, food insecurity (FI), and poverty. Overwhelming evidence indicates that obesity prevention evidence-based interventions (EBIs) reduce cancer risk, but the degree to which EBIs have been developed in culturally relevant ways or to reach large numbers of AI families is extremely limited.

Community-engaged dissemination and implementation (CEDI) strategies are needed across multiple social ecological levels to increase EBI adoption, implementation, and maintenance in AI communities. Our objective is to increase the reach of EBIs for cancer and obesity prevention among AI families who live in persistent poverty areas (PPAs). The proposed project, Reach through Equitable Implementation of Turtle Island Tales in AI Communities (REI-Turtle Island) is a participatory action research project designed to improve local capacity for sustained EBI impact.

Turtle Island Tales is a family-focused, home-based EBI for childhood obesity prevention named to acknowledge Turtle Island as the term for North America used by many AI communities. REI-Turtle Island will be conducted across four state Cooperative Extension Systems serving as Supplemental Nutrition Assistance Program Education (SNAP-Ed) agencies in AI communities with ~4,000 children and their families in PPAs in rural and frontier areas. REI-Turtle Island engages system, community, and organizational partners to identify, refine, and develop CEDI strategies to address both disease prevention FI. A Project Steering Committee and Local Community Advisory Boards will conduct iterative planning and evaluation using outcomes specified in the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

For Aim 1, we will facilitate and evaluate the reach of T-Tales in PPAs within AI communities in Montana, Oregon, South Dakota, and Wisconsin when delivered by Extension/SNAP-Ed; determine the effectiveness of T-Tales for health behavior change, and evaluate the reduction in FI among participating families by facilitating connections with community- and system-level resources (e.g., SNAP, WIC).

For Aim 2, we will evaluate the state-level adoption, implementation, and organizational maintenance capacity of Extension/SNAP and AI communities for T-Tales and determine budget impacts of implementing T-Tales into sustained Extension/SNAP-Ed delivery. We expect to generate a novel CEDI Strategies Toolkit to move obesity and cancer prevention EBIs into sustained community implementation and account for the unique social and cultural contexts in AI communities in PPAs. Findings will advance the field of CEDI science through the co-production of strategies to influence EBI adoption, implementation, and maintenance using an innovative conceptual framework that leverages social ecological, dissemination and implementation, behavioral, and health equity frameworks to prevent obesity and cancer in AI families in PPAs.