Assessing feasibility and community readiness to implement evidence-based obesity prevention policies in Native American reservations

Introduction: Environmental approaches are increasingly recommended to address obesity, yet little is known about the implementation of such approaches in Native American reservations. We assessed the feasibility of and readiness to implement obesity prevention and control policies recommended as part of the CDC’s Common Community Strategies and Measures for Addressing Obesity within tribal reservations in Oklahoma and California.

Methods: Diverse key stakeholders (n=138) in two Native American communities, selected for their differences in geographic setting, size, and potential opportunities to implement health policies, were asked to rate the likely success of several obesity prevention strategies in light of reservation culture, infrastructure, extent of leadership support, and funding.  Average feasibility scores were calculated and mean values ranked from highest (most feasible) to lowest (least feasible).  Tribal readiness to implement obesity prevention strategies was assessed using questions adapted from the Community Readiness Handbook. Means and standard deviations were evaluated for continuous variables and frequencies with percentages for categorical variables.  Readiness scores varied from 1 (no awareness) to 9 (high level of ownership and knowledge). 

Results: Both communities scored in the “Preplanning” stage of readiness. Both identified increasing availability of healthy foods in tribally-operated venues as the most feasible strategy.

Conclusions:  Formally assessing the feasibility of and community readiness to implement obesity prevention and control policies may provide a useful policy engagement framework for tribes to identify and prioritize promising strategies and take appropriate action steps toward policy implementation and/or maintenance.