title: Mississippi Communities for Healthy Living: Implementing a nutrition intervention effectiveness study in a rural health disparate region.
abstract: BACKGROUND
  Intervention research in rural, health disparate communities presents unique challenges for study design, implementation, and evaluation. Challenges include 1) culturally appropriate intervention components, 2) participant recruitment and retention, 3) treatment cross-contamination, 4) intervention delivery and data collection, and 5) potential measurement reactivity.
  
  
  OBJECTIVE
  The purposes of this paper are to 1) detail the methods of the MCHL study and 2) report baseline demographic characteristics of study participants. The secondary aim is to determine if study participants were engaging in behavior changes after enrollment and prior to intervention initiation.
  
  
  METHODS
  MCHL was developed using the RE-AIM planning and evaluation framework (reach, effectiveness, adoption, implementation, maintenance). Intervention components were based on Roger's diffusion of innovation attributes that promote adoption of a new innovation as well as on the psychosocial constructs of social support, self-efficacy and decisional balance. Rolling enrollment data collection was used to acquire sufficient sample size and a second data collection just prior to intervention implementation assessed measurement reactivity effects. Participant outcomes included diet quality, blood pressure, weight status, and quality of life. Cluster stratified assignment to one of two treatment arms was utilized to minimize cross contamination. Generalized linear models were used to compare enrollment measures between the two treatment arms while mixed model linear regression was used to test for changes in diet quality outcomes from enrollment to pre-intervention baseline.
  
  
  RESULTS
  There were no significant differences in participant demographic, anthropometric or clinical measures between the two treatment arms at enrollment. With the exception of total vegetables, none of the diet quality indicators were significantly different between enrollment and baseline timepoints.
  
  
  CONCLUSIONS
  Conducting nutrition intervention research in a rural health disparate region requires flexibility in adapting the recruitment, retention, and data collection procedures while maintaining a high level of scientific rigor. Negligible research participation effects, such as measurement reactivity, were noted in this population. However, further research is needed to identify methods to successfully recruit and retain Caucasian females to participate in community-based nutrition interventions in this region.
authors: Department of Nutrition and Food Systems, The University of Southern Mississippi, 118 College Drive #5172, Hattiesburg, MS 39406, United States. Electronic address: carol.connell@usm.edu.
authors: Carol L
authors: CL
authors: Connell
authors: Agricultural Research Service, United States Department of Agriculture, Stoneville, MS 38776, United States.
authors: Jessica L
authors: JL
authors: Thomson
authors: Department of Nutrition and Food Systems, The University of Southern Mississippi, 118 College Drive #5172, Hattiesburg, MS 3940, United States.
authors: Holly F
authors: HF
authors: Huye
authors: Department of Nutrition and Food Systems, The University of Southern Mississippi, 118 College Drive #5172, Hattiesburg, MS 3940, United States.
authors: Alicia S
authors: AS
authors: Landry
authors: Department of Nutrition and Food Systems, The University of Southern Mississippi, 118 College Drive #5172, Hattiesburg, MS 3940, United States.
authors: LaShaundrea B
authors: LB
authors: Crook
authors: Department of Nutrition and Food Systems, The University of Southern Mississippi, 118 College Drive #5172, Hattiesburg, MS 3940, United States.
authors: Kathy
authors: K
authors: Yadrick
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American; D001794:Blood Pressure; D001837:Body Weights and Measures; D054521:Cultural Competency; D003625:Data Collection / Q000379:methods; D004032:Diet; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D008922:Mississippi; D018579:Patient Selection; D011788:Quality of Life; D012107:Research Design; D012111:Residence Characteristics; D012424:Rural Population; D020377:Self Efficacy; D012944:Social Support; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Behavior change; Dietary Guidelines for Americans; Lower Mississippi Delta; Nutrition interventions; Rural populations; Study design