Exercise class hosted by Alabama CEAL partnersAccording to the CDC, most chronic disease can be traced back to a fairly short list of risk factors, among them poor nutrition and physical inactivity. To address these risk factors “Food Is Medicine” (FIM) interventions provide food prescriptions from healthcare providers and may include food boxes or food assistance in the form of medically tailored meals. Similarly, “Exercise is Medicine” (EIM) programs may incorporate a clinical physical activity assessment and include exercise prescriptions for patients, fitness counseling, or a list of resources for exercise programs. Typically, these types of FIM/EIM programs are implemented in clinical settings and directed at patients who are already diagnosed with a chronic disease or who are at high risk.
Mobile Market shopperBut could this approach be used at a community level to reach more people and improve health at the population level? To answer that question, a team led by Mona Fouad, M.D., MPH developed an innovative research study guided by community engaged research principles – Alabama Community Engagement Alliance (Alabama CEAL) Prescriptions for Community Health. “We are taking a model that has been used mainly in clinics on a one-on-one basis, and adapting it at the community level,” says Fouad, Director of the Healthy Living Center and Lead Principal Investigator for Alabama CEAL.
Alabama CEAL Prescriptions for Community Health starts with FIM/EIM concepts normally used in clinical settings, works with community members and organizations to adapt them and develop community level FIM/EIM prescription, and then implements them alongside community partners to evaluate their effect on healthy behaviors and, ultimately, on chronic disease and population health. The community is at the center of it all.
Community Health Working Group - Cohort 1 Kick OffAlabama CEAL starts by bringing together community members, leaders, and partner organizations into a Community Health Working Group (CHWG). The CHWG first identifies the communities’ more pressing areas of health concern. Then, together with nutrition and exercise specialists, the group designs a “Community Prescription” that uses FIM/EIM concepts and is tailored to each neighborhood, along with a community level intervention plan. Finally, Alabama CEAL Community Health Coaches—who are often from the very communities they serve—collaborate with community partners to disseminate the prescription and implement the intervention, leading community-wide events that get people engaged in the program. “The idea is if we really want to move the needle when it comes to improving health, we need to work with the whole community, and not just individuals within the community,” Fouad says.
For proof of the importance of community and partner engagement to this project, one need look no further than Dr. Michael Wesley, Sr. himself. He serves not simply an advisor or consultant, but as a Community Multiple Principal Investigator helping to lead the study, an unusual role for a community member in a university research study. “We’ve seen real leadership and camaraderie begin to develop, and a lot of attitudes begin to shift toward a desire to participate,” says Dr. Wesley. “We’re not interested in having just a few people going through a process and declaring them to be healthy. We want to saturate the community. So, community leaders have to be at the forefront of this program.”
If this sounds like a complex project, it is. Fortunately, the UAB Healthy Living Center had existing infrastructure, staff, and resources needed to ensure success in a project like Alabama CEAL Prescriptions for Community Health. The staff of the Center’s Partnerships and Engagement Program organize and maintain the CHWG, plan and conduct community meetings, and identify planning and implementation partners. The Participant Access to Research Core supports the recruitment and data collection efforts of the study, and, crucially, the Community Health Coach core spearheads the innovative community-level FIM/EIM intervention.
Community Coach with residentsThese Community Health Coaches (also known as community health workers) often live in the neighborhoods they serve and are vital to the study. Lori Bateman, Ph.D., R.D., associate professor in the UAB Division of General Internal Medicine and Population Science and a Multiple Principal Investigator on the study, emphasizes the importance of community members and Coaches to the success of the intervention. “A key aspect of this are the community members who work to design and implement these prescriptions. They know what’s likely to work in their communities and they make sure the project stays true to that.”
Through Coach-led community wellness events, exercise events, cooking demonstrations, and neighbor gatherings, community members take charge of not just their own health, but the health of the entire neighborhood. Each person who attends these events leaves with a personalized “prescription,” a guide to good nutrition, physical activity, and prevention and wellness tailored to their community. For each community, Alabama CEAL also works with implementation partners like Live HealthSmart Alabama to improve the built environment and bring Mobile Market and Mobile Wellness services to the community. By being tied to resources and services that are easily accessible in the area, Prescriptions for Community Health make it easier for people to follow guidelines and adhere to the program.
To evaluate the outcomes, the Prescriptions for Community Health study is following participating communities over the next two years to assess the effect of the initiative on community level health behaviors like good nutrition and physical activity. The study will also follow a cohort of individual participants to help assess how the program works through individual community members and help guide improvements. So far, early results look promising.
Brenda Holifield, president of the Kingston Neighborhood Association in Birmingham, says the community focus is the best part of the study. “We’ve become a family. We give each other hugs and just love on each other. We know we’re all in this health journey together, and we want each other to succeed. These programs have truly provided the opportunity for us to change ourselves for the better, in an easy and accessible way.”
This is just what Dr. Wesley wants to hear. “This is bringing the research out from the university and placing it in the community to get people engaged in taking charge of their health and their neighbor’s health.” Fouad agrees, “It’s about making it easier for people to live a healthy life. I don’t think there’s a more important outcome of research than that.”
Alabama CEAL Prescriptions for Community Health currently involves the Birmingham neighborhoods of Kingston, Bush Hills, East Lake, Titusville, with plans to expand to the Druid Hills, Fountain Heights, Norwood, Evergreen and Central City neighborhoods – along with Alabama cities Selma and Camden.