Journal of Racial and Ethnic Health Disparities

, Volume 6, Issue 6, pp 1144–1156 | Cite as

Community Readiness Model for Prevention Planning: Addressing Childhood Obesity in American Indian Reservation Communities

  • Kari Jo HarrisEmail author
  • Blakely Brown
  • Lindsey Shankle
  • Michael Tryon
  • Maja Pedersen
  • Sofia Kehaulani Panarella
  • Gyda Swaney



The community readiness model (CRM) is a stage-matched assessment protocol to assess community readiness to address a public health issue. To identify appropriate, culturally sensitive, and community-specific intervention strategies for preventing obesity in children, researchers, and community members formed a partnership to address childhood obesity within one American Indian Reservation.


The CRM guided 30 interviews in five communities to direct the team’s efforts in addressing obesity among children residing on the reservation. Interviews were scored across six dimensions on an anchored scale of one through nine; scores were then averaged to determine an overall readiness score for each community. A thematic analysis of interview responses aided in interpretation of the readiness scores and identified areas for prevention planning and intervention development.


The overall community readiness score for the communities was 2.9 (SD = 0.5), which falls between 2 (denial/resistance) and 3 (vague awareness) on the anchored rating scale. The thematic analysis resulted in a hierarchal classification scheme with six broad themes that corresponded to the CRM dimensions and 13 sub-themes.


The low readiness scores directed the team to implement corresponding strategies to increase awareness, while the thematic analysis suggested that action-based approaches might also be appropriate. The narrow range of scores suggest that community-wide assessments may be sufficient unless specific information is needed for each region of the community. The CRM may be an effective way to assess community readiness to address childhood obesity on an American Indian Reservation.


Childhood obesity Community-based participatory research Community Readiness Model American Indian 



The authors of this manuscript thank members of the Communities at Play Advisory Board for their valuable contributions and review of this manuscript.


This study was funded by the Eunice Kennedy Shriver National Institute Child Health & Human Development of the National Institutes of Health under Award Number R13HD080904. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Pan L, Mcguire LC, Blanck HM, May-Murriel AL, Grummer-Strawn LM. Racial/ethnic differences in obesity trends among young low-income children. Am J Prev Med. 2015;48:570–4.CrossRefGoogle Scholar
  2. 2.
    Bolin JN, Bellamy GR, Ferdinand AO, Vuong AM, Kash BA, Schulze A, et al. Rural healthy people 2020: new decade. Same Challenges J Rural Health. 2015;31:326–33.CrossRefGoogle Scholar
  3. 3.
    Phillips CD, Mcleroy KR. Health in rural America: remembering the importance of place. Am J Public Health. 2004;94:1661–3.CrossRefGoogle Scholar
  4. 4.
    Probst JC, Barker JC, Enders A, Gardiner P. Current state of child health in rural America: how context shapes children’s health. J Rural Health. 2018;34:s3–s12.CrossRefGoogle Scholar
  5. 5.
    Plested BA, Jumper-Thurman P, Edwards RW. Community readiness: a tool for effective community-based prevention. Prev Res. 1998;5:5–7.Google Scholar
  6. 6.
    Plested BA, Edwards R, Jumper-Thurman P. Community readiness for community change. Tri-Ethnic Center for Prevention Research: Fort Collins, CO, USA; 2009.Google Scholar
  7. 7.
    Israel BA, Eng E, Schulz AJ, Parker EA, Satcher D. Methods in community-based participatory research for health. 1st ed. San Francisco: Jossey-Bass; 2005.Google Scholar
  8. 8.
    Lawsin CR, Borrayo EA, Edwards R, Belloso C. Community readiness to promote Latinas’ participation in breast cancer prevention clinical trials. Health Soc Care Community. 2007;15:369–78.CrossRefGoogle Scholar
  9. 9.
    Kesten JM, Griffiths PL, Cameron N. 2015 A critical discussion of the Community Readiness Model using a case study of childhood obesity prevention in England. Health Soc Care Community. 2015;23(3):262–71. Scholar
  10. 10.
    Peercy J, Gray J, Thurman J, Plested J. Community readiness: an effective model for tribal engagement in prevention of cardiovascular disease. Fam Community Health. 2010;33:238–47.CrossRefGoogle Scholar
  11. 11.
    Kostadinov I, Daniel M, Stanley L, Gancia A, Cargo M. A systematic review of community readiness tool applications: implications for reporting. Int J Environ Res Public Health. 2015;12:3453–68.CrossRefGoogle Scholar
  12. 12.
    Ogilvie KA, Moore RS, Ogilvie DC, Johnson KW, Collins DA, Shamblen SR. Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska.(Report). J Community Health. 2008;33:248–58.CrossRefGoogle Scholar
  13. 13.
    Paltzer J, Black P, Moberg DP. Evaluating community readiness to implement environmental and policy-based alcohol abuse prevention strategies in Wisconsin. J Alcohol Drug Educ. 2013;57:27–50.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Pradeilles R, Rousham EK, Norris SA, Kesten JM, Griffiths PL. Community readiness for adolescents’ overweight and obesity prevention is low in urban South Africa: a case study. BMC Public Health. 2016;16:763.CrossRefGoogle Scholar
  15. 15.
    Andrews JO, Newman SD, Meadows O, Cox MJ, Bunting S. Partnership readiness for community-based participatory research. Health Educ Res. 2012;27:555–71.CrossRefGoogle Scholar
  16. 16.
    Freedman DA, Whiteside YO, Brandt HM, Young V, Friedman DB, Hebert JR. Assessing readiness for establishing a farmers’ market at a community health center. J Community Health. 2012;37:80–8.CrossRefGoogle Scholar
  17. 17.
    Blue Bird Jernigan V, Salvatore AL, Styne DM, Winkleby M. Addressing food insecurity in a Native American reservation using community-based participatory research. Health Educ Res. 2012;27:645–55.CrossRefGoogle Scholar
  18. 18.
    Kostadinov I, Daniel M, Stanley L, Cargo M. Assessing community readiness online: a concurrent validation study. BMC Public Health. 2015;15:598.CrossRefGoogle Scholar
  19. 19.
    Hildebrand DA, Blevins P, Carl L, Brown B, Betts NM, Poe T. Use of community readiness model to develop and evaluate a pilot culinary training program for school nutrition staff. J Nutr Educ Behav. 2018;50:118–124.e1.CrossRefGoogle Scholar
  20. 20.
    Gansefort D, Brand T, Princk C, Zeeb H. Community readiness for the promotion of physical activity in older adults—a cross-sectional comparison of rural and urban communities. Int J Environ Res Public Health. 2018;15:453.CrossRefGoogle Scholar
  21. 21.
    Mello MM, Wolf LE. The Havasupai Indian tribe case — lessons for research involving stored biologic samples. N Engl J Med. 2010;363:204–7.CrossRefGoogle Scholar
  22. 22.
    Hodge FS. No meaningful apology for American Indian unethical research abuses. Ethics Behav. 2012;22:431–44.CrossRefGoogle Scholar
  23. 23.
    Frerichs L, Brittin J, Robbins R, Steenson S, Stewart C, Fisher C, et al. SaludABLEOmaha: improving readiness to address obesity through healthy lifestyle in a Midwestern Latino community, 2011-2013. Prev Chronic Dis. 2015;12:E20.CrossRefGoogle Scholar
  24. 24.
    Pedersen M, Malich J, Harris K, Bodner B, Tryon M, France S, et al. Digital storytelling as a tool for health messaging on an American Indian reservation: a development process. 2017. San Diego, CA.Google Scholar
  25. 25.
    Brown B, Harris K, Dybdal L, Malich J, Bodnar B, Hall E. Feasibility of text messaging to promote child health in a rural community on an American Indian reservation. Health Educ J. 2019;78(5):557–569. Scholar
  26. 26.
    Institute of Medicine (US) and National Research Council (US) Committee on Childhood Obesity Prevention Actions for Local Governments. Local Government Actions to Prevent Childhood Obesity. 2018 Burns AC, Sanchez E, editors. National Academies Press (US); 2009 [cited Dec 17]. Available from: Accessed 17 Dec 2018.
  27. 27.
    Thurston WE, Meadows LM. Rurality and health: perspectives of mid-life women. Rural Remote Health. 2003;3:219.CrossRefGoogle Scholar
  28. 28.
    Armstrong DL. A community diabetes education and gardening project to improve diabetes care in a northwest American Indian tribe. Diabetes Educ. 2000;26:113–20.CrossRefGoogle Scholar
  29. 29.
    Cheyenne River Youth Project Promotes Health, Sovereignty & Economic Sustainability 2018 Native News Online [Internet]. [cited 2018 Dec 16]. Available from:
  30. 30.
    Adams AK, Scott JR, Prince R, Williamson A. Using community advisory boards to reduce environmental barriers to health in American Indian communities, Wisconsin, 2007-2012. Prev Chronic Dis. 2014;11:E160.CrossRefGoogle Scholar
  31. 31.
    Ornelas IJ, Deschenie D, Jim J, Bishop S, Lombard K, Beresford SAA. Yéego gardening! A community garden intervention to promote health on the Navajo nation. Prog Community Health Partnersh Res Educ Action. 2017;11:417–25.CrossRefGoogle Scholar
  32. 32.
    Brown B, Dybdal L, Noonan C, Pedersen MG, Parker M, Corcoran M. Group gardening in a native American community: a collaborative approach. Health Promot Pract 2019.
  33. 33.
    Brown B, Bahe A, Pedersen M, Harris KJ, France S, Smith M, et al. NP23 - growing strong generations strengthening project on an American Indian reservation: year 2 activities. J Nutr Educ Behav. 2018;50:S117.CrossRefGoogle Scholar
  34. 34.
    Friend S, Flattum CF, Simpson D, Nederhoff DM, Neumark-Sztainer D. The researchers have left the building: what contributes to sustaining school-based interventions following the conclusion of formal research support? J Sch Health. 2014;84:326–33.CrossRefGoogle Scholar
  35. 35.
    Brown T, Summerbell C. Systematic review of school-based interventions that focus on changing dietary intake and physical activity levels to prevent childhood obesity: an update to the obesity guidance produced by the National Institute for Health and Clinical Excellence. Obes Rev Off J Int Assoc Study Obes. 2009;10:110–41.CrossRefGoogle Scholar
  36. 36.
    Whelan J, Love P, Millar L, Allender S, Bell C. Sustaining obesity prevention in communities: a systematic narrative synthesis review. Obes Rev Off J Int Assoc Study Obes. 2018;19:839–51.CrossRefGoogle Scholar
  37. 37.
    Brown B, Harris KJ, Heil D, Tryon M, Cooksley A, Semmens E, et al. Feasibility and outcomes of an out-of-school and home-based obesity prevention pilot study for rural children on an American Indian reservation. Pilot Feasibility Stud. 2018;4:129.CrossRefGoogle Scholar
  38. 38.
    Maja Pedersen MS, Blakely Brown Phd, Kari Harris Phd, Sonja France, Mike Tryon MS, Aric Cooksley BA. Rural parent support of child health behavior in the home environment: a qualitative study on an American Indian Reservation. Glob Pediatr Health. 2019;6. Scholar
  39. 39.
    Ehlers DK, Huberty JL, Beseler CL. Is school community readiness related to physical activity before and after the ready for recess intervention? Health Educ Res. 2013;28:192–204.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.School of Public and Community Health SciencesUniversity of MontanaMissoulaUSA
  2. 2.Oregon Rural Practice-Based Research NetworkOregon Health and Science UniversityPortlandUSA
  3. 3.Summit Medical Fitness CenterKalispellUSA
  4. 4.Brown UniversityProvidenceUSA
  5. 5.Department of PsychologyUniversity of MontanaMissoulaUSA

Personalised recommendations