Pathways: lessons learned and future directions for school-based interventions among American Indians.
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.
Gittelsohn
Joel
J
Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA. jgittels@jhsph.edu
Davis
Sally M
SM
Steckler
Allan
A
Ethelbah
Becky
B
Clay
Theresa
T
Metcalfe
Lauve
L
Rock
Bonnie Holy
BH
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