New Mexico Implements and Expands Physical Activity Programs in Rural Communities
September 05, 2018 | ASTHO Staff
Since 1995, the University of New Mexico Prevention Research Center (UNM-PRC) has been working in partnership with underrepresented and under-resourced rural communities to improve health outcomes, education, and quality of life. In 2007, UNM-PRC partnered with Cuba, New Mexico, a rural-frontier, tri-ethnic community, to successfully implement evidence-based physical activity programs. Since then, UNM-PRC has scaled this program model to 31 other rural communities in New Mexico.
As part of a network of 26 CDC Prevention Research Centers, UNM-PRC provides ongoing evaluation and implementation expertise. ASTHO spoke with Sally Davis, director of UNM-PRC, to learn more about engaging rural communities, implementing evidence-based physical activity recommendations, and successfully adapting physical activity programs in other settings.
Adapting and Implementing Evidence-Based Programs in Rural Communities
In Cuba, UNM-PRC assisted the community by identifying evidence-based programs to adapt and implement to meet its needs. To accomplish this, each community selected five recommendations from CDC’s Community Guide to implement, including:
- Creating a community-wide campaign.
- Enhancing access to places for physical activity, combined with informational outreach.
- Evaluating community design and land use policies.
- Evaluating street-scale design and land use policies.
- Analyzing social support and individually-adapted health behavior changes.
“Of course, when you adapt, you have to stay pretty close to the fidelity of the original research,” says Davis of these recommendations and how they are implemented. “But it’s also important to make [these changes] feasible and culturally acceptable to the population you're working with.”
The recommendations that were especially responsive to rural adaptation resulted in community-wide campaigns and improvements to the built environment. For example, rural communities often have considerable public land available, which is essential for community planning and increased access to physical activity. Through its core research project, UNM-PRC helped the Cuba community create 20 miles of trails, develop sidewalks, and incorporate safe routes to school. In order to promote new physical activity opportunities, the community has since developed a variety of tools, including walking guides, informational kiosks, and a Step Into Cuba website, and it has hosted several community events.
Leveraging Community-Engaged Research and Partners to Address Rural Health Disparities
In 2007, concerns about chronic disease health disparities in Cuba led to the development of a local initiative to increase physical activity. To accomplish this, UNM-PRC formed VIVA-Step Into Cuba, an academic-community partnership, and offered technical assistance and evaluation expertise for implementing evidence-based strategies.
UNM-PRC and community partners then worked with state agencies and non-traditional programs, including the National Forest Service, the New Mexico Department of Transportation, the New Mexico Bureau of Land Management, the New Mexico Department of Health, and others to help other communities plan and develop the surrounding environment to increase opportunities for physical activity. “Those partners were instrumental in helping write grants and fund programs,” recalls Davis. “But it was the community that built all of it.”
Since then, UNM-PRC has worked closely with the state health department to develop and implement programs in rural communities, providing evaluation and implementation expertise and helping disseminate best practices. In addition, through its core research project, UNM-PRC has scaled the model developed in Cuba to 31 additional rural communities. “Our focus has been physical activity,” says Davis. “It is one of the most crosscutting behaviors when it comes to positively affecting physical and mental health.”
According to CDC’s Community Guide, changes to the built environment, including enhancing walking trails, building sidewalks, and increasing the safety of walkways through signage and lighting, can improve physical activity. For example, UNM-PRC, with the help of volunteers and partners, improved 20 miles of trails across seven locations in Cuba by building new trailways, planting flowers and trees, building parking areas, constructing kiosks with trail information, installing benches, and posting trail signage. The community also signed an agreement with the local school board to allow the community to use school-owned, cross-country running trails. In addition, the National Forest Service and the U.S. Bureau of Land Management incorporated recommendations based on UNM-PRC’s health impact assessment to develop sections of the trailways. NM-PRC is also evaluating increased access to physical activity through pedestrian counts, electronic trail counters, surveys, and interviews.
How Public Health Leaders Can Support and Amplify Rural Communities’ Efforts
Cultivating leaders within the community and at the department of health is essential to successfully engaging rural communities. “If you don’t bring people together to provide leadership, it’s not going to work,” says Davis.
Public health leaders should engage community leaders to champion public health issues, encourage community participation, and assist local coalitions with implementing and promoting public health programs. A health department or academic center can be an ideal partner for providing evaluation and implementation expertise within a community.
Public health leaders can also play a key role in sustaining public health programs in rural communities. Developing a logic model with the community can help evidence-based programs adapt while keeping the core elements of the intervention intact. Lastly, public health leaders can ensure these programs are sustainable by helping rural communities obtain and leverage adequate funding.