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Maintaining a healthy lifestyle can be affected by environmental conditions, individual circumstances and policies, especially for elderly members of our society. The financial and emotional toll from poor health is enormous, for society, for families, and especially for elders themselves. The primary purpose of this community-based participatory research project is to work in partnership with Navajo community organizations to improve the health of elderly individuals in the eastern area of the Navajo Nation. As the Core Research and Demonstration Project of the UNM Prevention Research Center, this project is being conducted collaboratively with the Navajo Area Agency on Aging (NAAA), the Indian Health Service (IHS) Navajo Area Crownpoint Service Unit, tribal health educators, and other interested community groups and individuals. The focus is to work together and share resources to promote physical activity and nutrition education and activities for Navajo elders, age 60 years and older.
The Navajo title of the project reflects the focus, translated as follows: Ats’íís means the physical body; Yá’át’éehgo, when it is in good condition, homeostasis; and Áhool’á, as extending there, proceeding into the future.
The basis for planning this feasibility project was a previous pilot study in which senior center staff and community health personnel worked closely with CHPDP researchers to identify the physical activity and nutrition strengths and needs of Navajo elders. They sought to identify factors at the individual, environmental and policy levels that influenced choices that were made by Navajo elders that had an impact on their health. The pilot study provided information needed for program development, and for partners to assist in designing the current feasibility project. The resulting project consists of a culturally-relevant set of training and education modules for Navajo elders at the senior centers to enable them to make healthful choices about physical activity and nutrition. As a community-based collaborative effort, the project involves participation of senior center staff and Navajo elders in nutrition and physical activity training sessions, and the enhanced nutritional quality of senior center meals.
During the first phase, monthly meetings are held by CHPDP researchers and community partners, to plan trainings for senior center staff, volunteer elders and other project participants. At these meetings, community partners provided input about training topics, who should participate (senior center staff, elders from each center) and what materials are needed for activities planned after the trainings are completed. Community planning group participants include individuals from the central NAAA office, the Navajo Nation Special Diabetes Project, IHS Health Promotion and Disease Prevention, and senior center staff and Navajo elders from the Eastern Navajo area. To expand the impact and level of input, the participating senior centers made presentations to their chapters and councils on aging to obtain resolutions and support for Healthy Path.
Through this planning process the modules and materials used in the pilot project were revised and enhanced, and two physical activity and two nutrition education modules were developed. For the physical activity module, eight elders volunteered as “models” for the physical activity cards that are part of the training activities. Activities are described on one side of the card and illustrated on the other side with elders demonstrating each activity. To encourage interest in nutrition education, both for younger and elder Navajo community members, the planning group sponsored a cooking demonstration of traditional foods during Spring 2003. Three elders led the demonstration preparing blue corn mush, bread, and pancakes and 'puberty' (Kineldaa) cake, explaining what they were doing as they proceeded, and answering numerous questions from observers. Photos were taken of the finished products to be used for food model cards with nutritional information about these foods, that would be included with food models of non-traditional foods for the nutrition education module.
During Summer 2003, senior center staff from nine centers, and other community health workers were trained by CHPDP personnel and community partners. During the two months following the training sessions, these trained staff delivered the four educational modules in their senior centers to elders. Technical assistance was provided by CHPDP personnel to address program fidelity and integrity. In addition, about 135 elder participants and those presenting the health promotion information were given opportunities to provide their assessments of sessions so that future sessions could be improved. Through interviews, the degree of "adoption" of training modules by trainees were also assessed, to determine their acceptance and sustainability potential.
The second phase, which began the end of September 2003, was to plan which components of the first phase to continue and what new components to add, whether to add new nutrition and physical activity modules or activities, or whether additional partners or centers could be added.
A very exciting 'next step' for collaborating partners was the development of a proposal for a full-scale study based on this feasibility project. This five-year, full-scale study served as the core research project for CHPDP's renewal proposal as a Prevention Research Project. This study could expand its reach to the entire Navajo Nation as well as other American Indian communities in the Southwest.
For more information about this project, please contact Dr. Leslie Cunningham-Sabo, at (505) 272-4462 or ldcunningham-sabo@salud.unm.edu.
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