Chickasaw Nation

Chickasaw Nation SNAP-Ed Coordinated Programming and Evaluation to Prevent Type 2 Diabetes

The Eagle Adventure program was developed through a collaboration between the Chickasaw Nation Nutrition Services SNAP-Ed Program and the Oklahoma State University Department of Nutritional Sciences’ Solution-based Health Innovations and Nutrition Excellence (SHINE) partnership in Indian Country. In 2009, the systematic program was designed for youth and their families in grades one through three after extensive formative research indicated type 2 diabetes as a major concern among parents and elders. Recognizing multiple levels of influence are necessary to impart behavioral change, the team used the socioecological model (SEM) as the framework for development of the program and evaluation processes.

Eagle Adventure includes culturally relevant in-class education and take-home, family-based health homework (Individual), school announcements (Environmental Settings), news and radio (Sectors of Influence) to infuse and evaluate consistent messages at multiple levels of the SNAP-Ed Evaluationa Framework. An after-school component was designed as part of the coordinated approach to allow for increased exposure to healthful messages and moving activities in the after-school environment. Additionally, a complementary social marketing campaign, “Diabetes is Not Our Destiny,” was designed to reach multiple generations with consistent messages conveying type 2 diabetes is preventable through healthy lifestyle behaviors, such as fruit, vegetable and physical activity choices.

The team conceptualizes educational approaches as “living,” in that evaluation informs best practices, program changes and expansion. We continuously work with evaluation results to “build out” approaches to address multiple levels of influence, including policy, systems and environmental change efforts. The evaluation processes (Table 1) were developed in coordination with program development and are informed by the SEM. The indicators are consistent with SNAP-Ed guidance and easily align with the SNAP-Ed Evaluationa Framework. Since the release of the framework and extension of programming cycle, the team has used the framework as a guide to identify opportunities and processes to address effectiveness and maintenance and population level components of the framework. Conceptualizing program and evaluation as living and working to build out programming to address multiple levels of influence has enabled the team to easily embrace the SNAP-Ed Evaluationa Framework.

Table 1 - Chickasaw Nation SNAP-Ed evaluation processes support evaluation of indicators outlined in the SNAP-Ed Evaluation Framework. Table with 4 columns and 4 rows.<br />
Row 1: Individual Level<br />
Row 1, column 1: Readiness & Capacity, Goals & Intentions: ST1: Healthy Eating - Pre- and post-student in-class and after-school evaluation; ST3: Physical Activity and Reduced Sedentary Behavior - Pre- and post-student in-class and after-school evaluation.<br />
Row 1, column 2: Changes, Behavioral Changes. MT1: Healthy Eating: Pre- and post-student in-class and after-school evaluation; post-only evaluation with parents to identify student- and family-based changes after participating in the EA; Post-in-class student evaluation identifying activities practiced at home with family members. MT 3: Physical Activity and Reduced Sedentary Behavior: Pre- and post-student in-class and after-school evaluation; Post-only evaluation with parents to identify student- and family-based changes after participating in the EA; Post-in-class student evaluation identifying activities practiced at home with family members.<br />
Row 1, column 3: Effectiveness & Maintenance, Maintenance of Behavioral Changes. LT1: Healthy Eating: In planning process: Repeat of parent evaluation at six months and one year post-EA participation. LT3: Physical Activity and Reduced Sedentary Behavior: In planning process: Repeat of parent evaluation at six months and one year post-EA participation.<br />
Row 2: Environmental Settings<br />
Row 2, Column 1. Readiness and Capacity, Organizational Motivators. ST5: Need and Readiness: Teacher, school administrator and food service personnel focus groups. ST6: Champions: Teacher, school administrator and food service personnel focus groups and teacher post-EA survey  ST7: Partnerships: In-person conversations and discussions with school districts, health departments, Habitat for Humanity and other community organizations.<br />
Row 2, Column 2. Change, Organizational Adoption & Promotion. MT5: Nutritional Supports: Teacher survey post-EA implementation. MT6: Physical Activity and Reduced Sedentary Behavior Support: Teacher survey post-EA implementation.<br />
Row 2, Column 3. Effectiveness & Maintenance, Organizational Implementation & Effectiveness. LT5: Nutrition Supports Implementation: In planning process: Teacher survey post-EA implementation six months and one year. LT6: Physical Activity Supports Implementation: In planning process: Teacher survey post-EA implementation six months and one year. LT8: Media Coverage: Television reach, radio spot counts, outdoor board counts, direct mailer reach, newspaper counts, magazine counts. LT11: Unexpected Benefits: Teacher survey post-EA implementation; In planning process: Teacher survey post EA implementation six months and one year.<br />
Row 3: Sectors of Influence<br />
Row 3, Column 1. Readiness & Capacity, Multi Sector Capacity. ST8: Multi-sector partnerships and planning: In-person conversations and discussions with tribal partners, health departments and other community organizations.<br />
Row 3, Column 2. Changes, Multi-sector Changes. MT9: Education Policies: Teacher, school administrator and food service personnel focus groups. MT12: Social Marketing: Television reach, radio spot counts, outdoor board counts, direct mailer reach, newspaper counts, magazine counts.<br />
Row 3, Column 3. Effectiveness & Maintenance, Multi-Sector Impacts.LT18: Commercial Marketing of Healthy Foods and Beverages: NEMS/FAMS baseline and post-EA message implementation. LT19: Community-wide Recognition Programs: Diabetes is Not Our Destiny message recognition and behavioral survey; In planning process: Survey development for EA recognition.<br />
Column 4 (spans all 3 rows): Population Results (R) Trends & Reduction in Dispartities. R2: Fruits and Vegetables, R7: Physical Activity and Reduced Sedentary Behavior, R9: Healthy Weight: Review and charting of BRFSS and YBRFSS county data as available by racial/ethnic and income groups, Review and charting of Chickasaw Nation Medical Center data.<br />
Along the bottom of the table: Changes in Societal Norms and Values: Recognition that type 2 diabetes can be prevented as measured by Diabetes is Not Our Destiny message recognition and behavioral survey.<br />
End Table.<br />
This project is an initiative of the Chickasaw Nation SNAP-Ed program and Oklahoma State University, Solution-based Health Innovations and Nutrition Excellence (SHINE) Partners in Indian Country.

Peer reviewed articles/reports:
Angelina Stovall-Amos, Stephany Parker, Sara Mata, Jill Fox, Teresa Jackson, Sarah Miracle, & Janice Hermann. 2014. Eagle Adventure: School-Based Type 2 Diabetes Prevention Program Results in Improved Outcomes Related to Food and Physical Activity. Journal of Extension [Online], 52(6) Article6TOT6. Available at: http://www.joe.org/joe/2014december/tt6.php

U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, SNAP Education and Evaluation Case Study Report: Chickasaw Nation Nutrition Services’ Eagle Adventure Program by Stacy Gleason, Jonathan Blitstein, Vivian Gabor, Sheryl Cates, Loren Bell, and James Hersey. Project Officer: Sara Olson, Alexandria, VA: January 2012.

Teresa Jackson, Stephany Parker, Janice Hermann, Sarah Miracle, Chiquita Briley. 2012. Understanding Native American Women’s Views of Physical Activity to Inform Family-Based Program Development. Journal of Extension[Online], 50(4) Article4T0T7. Available at: http://www.joe.org/joe/2012august/ tt7.php

Stephany Parker, Toma Hunter, Chiquita Briley, Sarah Miracle, Janice Hermann, Jean Van Delinder, and Joy Standridge. 2011. Formative Assessment Using Social Marketing Principles to Identify Health and Nutrition Perspectives of Native American Women Living within the Chickasaw Nation Boundaries in Oklahoma. Journal of Nutrition Education and Behavior. 43(1), 55-62.

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