Community Member and Stakeholder Perspectives on a Healthy Environment Initiative in North Carolina.
BACKGROUND
The North Carolina Community Transformation Grant Project (NC-CTG) aimed to implement policy, system, and environmental strategies to promote healthy eating, active living, tobacco-free living, and clinical and community preventive services to advance health equity and reduce health disparities for the state's most vulnerable communities. This article presents findings from the Health Equity Collaborative Evaluation and Implementation Project, which assessed community and stakeholder perceptions of health equity for 3 NC-CTG strategies: farmers markets, shared use, and smoke-free multiunit housing.


METHODS
In a triangulated qualitative evaluation, 6 photo elicitation (PE) sessions among 45 community members in 1 urban and 3 rural counties and key informant interviews among 22 stakeholders were conducted. Nine participants from the PE sessions and key informant interviews in the urban county subsequently participated in a stakeholder power analysis and mapping session (SPA) to discuss and identify people and organizations in their community perceived to be influential in addressing health equity-related issues.


RESULTS
Evaluations of the PE sessions and key informant interviews indicated that access (convenience, cost, safety, and awareness of products and services) and community fit (community-defined quality, safety, values, and norms) were important constructs across the strategies. The SPA identified specific community- and faith-based organizations, health care organizations, and local government agencies as key stakeholders for future efforts.


CONCLUSIONS
Both community fit and access are essential constructs for promoting health equity. Findings demonstrate the feasibility of and need for formative research that engages community members and local stakeholders to shape context-specific, culturally relevant health promotion strategies.
Public Health Leadership Program, Gillings School of Global Public Health, 4111 McGavran-Greenberg Hall, University of North Carolina at Chapel Hill, CB no. 7469, Chapel Hill, NC 27599-7469. Email: lori_carter-edwards@unc.edu. Dr Carter-Edwards is also affiliated with the Department of Health Behavior and the UNC Center for Health Promotion and Disease Prevention at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Lori
L
Carter-Edwards
UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Abby
A
Lowe-Wilson
Cancer Control Education Program, Lineberger Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Mary Sherwyn
MS
Mouw
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Janet Yewon
JY
Jeon
Department of Leadership Studies, North Carolina Agricultural and Technological State University, Greensboro, North Carolina.
Ceola Ross
CR
Baber
Department of Health Behavior, Gillings School of Global Public Health, and UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Maihan B
MB
Vu
Department of Public Health Education, North Carolina Central University, Durham, North Carolina, and Chronic Disease and Injury Section, North Carolina Division of Public Health, Raleigh, North Carolina.
Monique
M
Bethell
D000328:Adult; D001294:Attitude to Health; D003132:Commerce / Q000379:methods*; D003159:Community-Institutional Relations; D003627:Data Interpretation, Statistical; D004779:Environment Design; D005006:Ethnicity; D005260:Female; D005523:Food Supply; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D015397:Program Evaluation; D036301:Qualitative Research; D012424:Rural Population / Q000706:statistics & numerical data; D061845:Smoke-Free Policy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D014675:Vegetables