title: Pathways: lessons learned and future directions for school-based interventions among American Indians.
abstract: BACKGROUND
  Pathways, a multicenter study to test the effect of a school-based program to prevent obesity in American Indian children, yielded many benefits and encountered many challenges. This paper explores what we have learned from this study and examines possible future directions.
  
  
  METHODS
  Information presented in this paper is based on formative research, study results, and discussions with staff and investigators.
  
  
  RESULTS
  Some of the lessons learned relate to having a strong relationship with the tribes, how best to engage the communities, the importance of formative research and achieving standardization in culturally diverse settings, how to incorporate cultural information into curricula, and the importance of family involvement. One of the strengths of the study was the collaborative process that teamed American Indian and non-American Indian investigators and staff. Researchers recognized that they must work in cooperation with research participants including their schools and communities to address challenges, to ensure accurate findings and analyses, and to share benefits.
  
  
  CONCLUSIONS
  The lessons learned from Pathways offer valuable insights for researchers into successful approaches to the challenges inherent in research in American Indian communities, particularly in schools, and how to maximize the benefits of such a study.
authors.affiliation: Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA. jgittels@jhsph.edu
authors.forename: Joel
authors.initials: J
authors.lastname: Gittelsohn
authors.forename: Sally M
authors.initials: SM
authors.lastname: Davis
authors.forename: Allan
authors.initials: A
authors.lastname: Steckler
authors.forename: Becky
authors.initials: B
authors.lastname: Ethelbah
authors.forename: Theresa
authors.initials: T
authors.lastname: Clay
authors.forename: Lauve
authors.initials: L
authors.lastname: Metcalfe
authors.forename: Bonnie Holy
authors.initials: BH
authors.lastname: Rock
mesh_terms: D002648:Child; D003256:Community Participation; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D015337:Multicenter Studies as Topic; D009765:Obesity / Q000208:ethnology* / Q000517:prevention & control*; D011322:Primary Prevention; D015397:Program Evaluation; D012574:Schools; D014481:United States