Community-based participatory research at A&T: Engaging a church to help fight childhood obesity

Childhood obesity, like any other problem in our society, isn’t a discrete issue in and of itself. It’s not just a matter of what kids eat and how active they are.

It’s connected to everything else in a child’s world – what kind of food the family is able to bring home, whether the community provides places and opportunities for active play, cultural norms for cooking and eating, and more.

And then there are society’s contributions to children’s lives, including videogames, junk food, and schools too preoccupied with other crises to think much about providing adequate physical activity.

In Halifax County, North Carolina, these factors converge in a generation of children with too much fat and sugar in their food and too little physical activity. Children with parents who have little understanding of the nutrition their kids need. And children living in a community that offers few positive options for them or their parents.

Halifax County has the fifth highest obesity rate in the state. County residents are well aware and concerned over the rural area’s lack of health-promoting resources.

“It’s a community that wants to change, to be healthy,” says Dr. Sharon Warren Cook, professor of social work North Carolina A&T.

These are among the reasons why Dr. Cook and Dr. Meeshay Williams-Wheeler, associate professor of family and consumer sciences, chose Halifax County for an innovative project addressing childhood obesity.

The problem

Although rural life has its own particular health challenges, childhood obesity is a problem all across North Carolina and the United States. The nation’s rate of childhood obesity has tripled in the past 30 years. It’s an especially problematic condition because it puts children at risk of potentially lifelong health problems that used to be limited to adults, such as diabetes, high blood pressure, and high cholesterol.

The National Survey of Children’s Health reports that 19 percent of North Carolina children aged 10 to 17 are obese. Obesity is increasing among children in most age, gender, racial/ethnic, and socioeconomic groups.

Due to the disproportionate impacts of obesity and health diseases among African American children, there is an especially strong need to encourage physical activity and healthy eating in African American families.

African Americans, Native Americans, and low socioeconomic status (SES) populations continue to experience substantial health disparities compared to white Americans and higher SES populations. Health disparities based on racial/ethnic, social class, and rural-urban factors are largely influenced by behavioral and social factors.

Community-based participatory research

One way to address those issues is by going beyond the conventional health care system to include approaches that are more integrated with the entirety of a family’s life.

A process called community-based participatory research has emerged as a way to bring both education and social action to bear on health issues. At the same time, it provides scientific insight into promoting health, preventing disease, and eliminating health disparities. It has become recognized as an effective way to transfer knowledge gained from evidence-based research to the communities that need it.

Drs. Cook and Williams-Wheeler went to Enfield in Halifax County to use this strategy to attack childhood obesity from a new direction.

“Where are the hubs of power in the community?” Dr. Cook asks. “Where are the hubs of authority that people respond to?”

Instead of working through doctors’ offices or public schools, the researchers wanted an entirely different venue. Parents can feel isolated, blamed, even threatened when discussing their children’s needs in such settings.

The place the researchers needed would be one where people already are in the habit of going, where they’re comfortable and together with their families, and where they trust the authority of the institution. In Enfield, North Carolina, First Baptist Church is just that kind of place.

A long-term relationship

The research team’s participatory methodology emphasized developing a close, collaborative relationship with families, the church, and community leaders with a long-term engagement and commitment to the health and well-being of children and families.

The project was motivated by the national “Let’s Move” initiative against childhood obesity, led by First Lady Michelle Obama. Dr. Cook knows Enfield well. It’s her hometown.

Now in their third year, A&T researchers are partnering with the church to deliver some temporal good news: Better nutrition isn’t as hard – or as expensive – as you think. Getting kids more active can be as simple as providing chalk for hopscotch, ropes for jumping, and balls for kicking and chasing. And changing traditional ways and lifelong habits is easier together than alone.

To reach kids, first you have to reach parents. The researchers started by developing relationships with the church and parents who wanted to help their children. A group of a dozen volunteers quickly grew to 30.

While the project focused on childhood obesity, the researchers found themselves working with parents as much as children. The parents’ enthusiasm for the project and their knowledge that they need to eat better themselves guaranteed that changes in the children’s diets would be part of their entire families’ healthier lives.

No quick fix

The researchers took a long-term, gradual approach. An abrupt, cold-turkey blitz of salads and cooking light is no way to change lifelong diets heavy on salt, fat, and fried food. An initial step was simply to introduce tips and recipes for healthy cooking and eating through the Sunday church bulletin. The researchers’ visits to Enfield included play time for the kids with fruit, granola bars, and water for snacks.

While the researchers gathered the necessary initial data with surveys and focus groups, they also held cooking demonstrations using healthier cooking techniques (alternatives to salt, cooking spray instead of fat) applied to healthier foods (fresh instead of canned, no mac and cheese).

“Part of this is getting people to see things differently,” Dr. Cook says.

The immediate result was lunch for everyone, grilled chicken one time, turkey chili another. And everyone loved it.

“It was good! But …”

• “… who can afford it?”
• “… my family won’t eat it. “
• “… that’s not the way Momma cooked.”

Changing perceptions is always a challenge, and one of the most perverse misperceptions among the parents is that fast food is cheaper than healthy food.

Changing habits is long, hard work, too, and one of the toughest habits to break is getting the family – especially children! – to try something new.

Perhaps toughest of all is changing traditions, and one of the most dearly held is the way Momma cooked. Especially if Momma is still there, throwing that lard in with the vegetables every night.

“We were facing an intergenerational legacy of what good food is,” Dr. Cook says.

Benefits of participatory engagement

As hard as it is to change, the families have some powerful factors in their favor. The researchers continue to show them new ways to meet their needs and overcome the limits of income and time. The interdisciplinary team includes graduate student researchers who address the nutritional and activity challenges of both parents and children.

Because Dr. Cook grew up in Enfield, she’s a credible source of information. She knows first-hand where they’re coming from. She’s proof that it can be done.

The parents have great motivation, too — their goal is healthier lives for their children. And the church provides a strong peer support network to help them stay on course.

The group also has engaged and effective community leaders. The Rev. Alvin Harmon of First Baptist participates in all of the researchers’ visits to the church. Enfield Mayor Barbara Simmons took inspiration from the program and helped create a weekly farmers market in the town, bringing an oasis of fresh, healthy produce to a food desert.

The market is a great step for the entire community, and the access it provides to local vegetables and fruit is a boon to the sustainability of the parents’ progress.

Sustainability: The final challenge

Sustainability is a major concern. Drs. Cook and Williams-Wheeler are funded by a three-year U.S. Department of Agriculture grant. When the team’s work is complete later this year, the volunteer families will be better off, but no one is immune from the danger of slipping back into old habits.

In addition, the community’s larger economic and social problems will remain. There will still be parents with two jobs, little money, and no time to cook. The community, as ever, will be short of activities for kids and access to healthy foods.

But progress has been made. And the volunteer families will have much to sustain their progress.

Parents will have three years of experience building new and positive habits, skills in healthier cooking, and a better understanding of their developing children’s needs and how to meet them.

The First Baptist community will continue to provide vital peer support. The church will keep growing its cookbook of healthy recipes, available for anyone to learn from in the back of the sanctuary with the pamphlets and flyers.

The children will know more about the food they eat – some couldn’t name a fruit or vegetable two years ago. They’ll know that pieces of banana dipped in yogurt and rolled in granola is a great treat. And they’ll know more about the benefits (fun) of running and playing in the real, non-virtual world.

For their part, Drs. Cook and Williams-Wheeler and their team will have evidence that with their community-based participatory approach and an effective partner like First Baptist, they can make a difference in the lives of children, families and communities.

Support for this research is provided by the U.S. Department of Agriculture through the Evans-Allen program, one of the major sources of funding for agricultural research at A&T and other 1890 land-grant universities.

The researchers and Dr. Valerie Giddings, chair of the Department of Family and Consumer Sciences, will report on their work in an upcoming issue of the International Journal of Humanities, Social Science, and Education. Click here for a draft of their article (PDF), which served as one of the sources for this report.