Abstract

Characterizing Implementation Strategies and Behavior Change Techniques used by Rhode Island Health Equity Zones to Prevent Chronic Disease

Emily Fu, PhD, MPH¹, Alison Tovar, PhD, MPH², Hannah Frank, PhD³ and Lauren Bohlen, PhD²
(1)University of Chicago, Chicago, IL, (2)Brown University School of Public Health, Providence, RI, (3)The Warren Alpert Medical School of Brown University, Providence, RI

APHA 2025 Annual Meeting and Expo

Background: Chronic diseases, including cardiovascular disease and diabetes, are significant drivers of poor health. Despite public health chronic disease prevention efforts, many in the US fail to meet dietary and physical activity recommendations. In Rhode Island (RI), Health Equity Zones (HEZs; n=15) address health inequities through place-based approaches focusing on food security and physical activity while reaching 80% of the population. Despite the promise of community-wide delivery of evidence-based interventions, no prior studies have characterized community-initiated methods used to support uptake (i.e., implementation strategies and behavior change techniques).

Objective: To understand community-wide delivery of evidence-based interventions that may facilitate scaling and sustainment of HEZ efforts.

Methods: Annual process evaluations (2024) from all HEZs were reviewed by two raters to categorize HEZ implementation efforts and intervention activities related to improving diet and physical activity. The Behavior Change Technique (BCT) Taxonomy v1 and Expert Recommendations for Implementing Change (ERIC) strategies were used, following established coding guidelines. Data were tabulated by HEZ, and by behavior.

Results: In each HEZ, between 3-62 ERIC strategies and BCTs were used to increase physical activity or reduce food insecurity. Approximately 32 out of 73 ERIC strategies, and 30 out of 93 BCTs were identified. The most frequently coded ERIC strategies were: Promote network weaving (n=49), Build a coalition (n=23), Access new funding (n=19), Develop resource sharing agreements (n=18), and Tailor strategies (n=13). The most frequently coded BCTs were: Restructuring the social environment (n=39), Instruction on how to perform a behavior (n=33), Social support (practical) (n=22), Adding objects to the environment (n=21), and Social support (unspecified) (n=18). Most (n=11) HEZs used ERIC strategies and BCTs to plan and implement accessible farmer’s markets, food pantries, or produce deliveries to reduce food insecurity; and 8 used strategies and techniques to enhance outdoor spaces or offer free exercise classes to increase physical activity.

Conclusion: HEZs utilized implementation strategies and BCTs to foster partnerships and address food insecurity and physical activity.

Public health implications: A rigorous evaluation of HEZ implementation processes will provide insights into adapting and scaling interventions, contributing to a broader understanding of effective strategies for community-driven chronic disease prevention.

Chronic disease management and prevention Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs