Active Ottumwa Podcast Episode 1 Transcript

Active Ottumwa Podcast Episode 1

Hannah Shultz: Welcome to A Community on the Move: The Story of Active Ottumwa. Active Ottumwa is a community-based research project that encourages all adults to be more active. Ottumwa community members, and the University of Iowa used the latest research to design this project. The research project for Active Ottumwa has concluded but the Active Ottumwa program continues under the leadership of Hy-Vee of Ottumwa and with the positive support of community organizations. In this series we’re learning from people involved in the project about what worked well, what they learned along the way, and the impact Active Ottumwa had on the community. Over the next 10 episodes, we will talk about many aspects of the Active Ottumwa project to learn about the successes, challenges, lessons learned, pride, and humility that went into this project. My name is Hannah Schultz and I am the host for this series, and I’m learning about this program along with you. I work at the University of Iowa College of Public Health but have not been affiliated with Active Ottumwa until we started planning this podcast series. Working on this series has been a joy. I’ve been impressed every step of the way, by the passion, commitment, dedication, and persistence of all involved in this project. and I am very excited to share this with you. One of the many reasons I’ve been impressed by this project and am so excited to share it with you is the active participation and inclusion of people representing many different communities, organizations, and interests in Ottumwa. The focus of Active Ottumwa was on physical activity, which came out of a community survey highlighting that this was a need for the community. The project used community resources to promote and support active living and physical activity across the community.

I’m joined by Becky Bucklin, Sandy Berto, Rima Afifi, and Barbara Baquero. Becky, Sandy, and Rima work with the Prevention Research Center at the University of Iowa College of Public Health. Rima is the current director of the Prevention Research Center. Becky has been the project manager of the Active Ottumwa project and Sandy was the field coordinator of activities of Active Ottumwa on the ground. Barbara was with the Prevention Research Center when the project began and was the director of the project for four and a half years. She is now at the University of Washington School of Public Health. We are grateful for all of these guests to be able to join us today to talk about the early days of planning and implementing the project. In today’s episode we’ll introduce the project. In other episodes we’ll dive deeper into many of the topics from today’s show. We’ll talk with Ottumwa community members, highlight the Community Advisory Board, discuss marketing and promotion, and dive into what enabled this project to be successful, and many other aspects of Active Ottumwa in the coming episodes. So we’re going to get started just with a little bit of background of Active Ottumwa and the community of Ottumwa. So, Rima, I’m hoping in your current role as the director of the Prevention Research Center, could you talk about what the Prevention Research Center or the PRC is?

Rima Afifi: So, the University of Iowa Prevention Research Center for Rural Health is one of 25 Prevention Research Centers that are funded by the Centers for Disease Control and Prevention. Our University of Iowa Prevention Research Center, and I’ll say PRC for short, was first funded in 2002, and it’s housed in the College of Public Health at the University of Iowa, and specifically in the Department of Community and Behavioral Health. The 25 PRCs constitute a network of academic community and public health partners that conduct applied public health research across the United States. PRCs usually have two main components. A center component that provides technical assistance and training to organizations, intended to enhance well-being broadly defined and to support pilot research projects. And then the second sort of main component is always a core research project. And what we’re going to be talking about more throughout this episode is that core research project of the University of Iowa’s PRC. The mission of the University of Iowa’s Prevention Research Center, or PRC, is to improve the health of rural communities in Iowa, the surrounding states and the United States overall. And we’re the only PRC with a specific focus on rural health, although there are other PRCs that work in rural areas. I wanted to just talk a little bit about why rural health was important. So, according to the US Census Bureau, 25% of all US residents live in rural communities of less than 2500 people, and of the 99 counties in Iowa 90 of them are classified as rural. Rural Americans face multiple barriers that can adversely affect their health such as higher rates of poverty, geographic obstacles to health care, and less access to health care providers. Rural areas are also changing demographically. They’re often older and also becoming more diverse which is quite exciting. The University of Iowa’s Prevention Research Center has three main thematic areas of focus and those are rural or micropolitan area health disparities, and we’re going to talk later about what a micropolitan area is and the difference between micropolitan and rural. So that’s the first focus. The second is advancing understanding of the relationships between social and structural determinants of health and health outcomes in those rural and/or micropolitan areas. And then the third area of focus is developing and testing interventions for or adapting evidence-based interventions to rural and or micropolitan populations. Just sort of rounded out our technical assistance and training, our pilot projects, and our core research project, all focus on at least one of those thematic areas. And we do all of our work in a participatory partnership approach. And this means that community partners and community residents are involved in the identification of the issue that we want to work on together and the potential solutions in that community. Those types of participatory approaches ensure that our work is more responsive, relevant, adapted, acceptable, and sustainable. And it also is important because it lifts up voices of community members and starts from a base of strengths and assets and needs, and sort of engages everybody in preservation of culture and dignity.

Hannah Shultz: Now we’re going to hear from Barbara to learn more about how Active Ottumwa came to be and what the goals were when the project began.

Barbara Baquero: You know, sort of in terms of the goal, I think about the goal, like of Active Ottumwa now and sort of in retrospect from the community, the community partnership, the community academic partnership that we had an also sort of the research goals right that makes me think about what did we say we’re going to do. So in terms of what we propose the goals were really to take evidence-based interventions around physical activity like what Rima is mentioning, and then scaling it up in trying it in a different context right? So one of the things that we realized when we started planning the project was that a lot of the evidence to promote health in health behaviors like physical activity, were all concentrated in urban spaces, in big cities, right and that’s, that’s part of that gap that we find in terms of the axis of health promotion interventions that rural communities may have. So we decided to take that on and say okay can we take those good evidence that we know in terms of promoting physical activity and adopt it and implement it in the context of a rural micropolitan community. And so, our research goal was to test that and really see what the intervention and these strategies continue to be effective to improve physical activity. But in terms, so that’s sort of the main research goal that was, that was the research, the partnership goal right, but I think in Active Ottumwa became about, you know, it is all about promoting and supporting active living and physical activity across the community so I think that’s what, that’s one of the innovations and the challenge and the beauty of Active Ottumwa is that we just didn’t want to concentrate on a group of individuals in the community, but we really wanted to see can we motivate people, can we promote, can we support all members of the community regardless of your level of physical activity, your socioeconomic status, your ethnicity. Be active right, and feel like you belong in this community, that you can be you know can walk and make that part of your actively being right. So I think is also Active Ottumwa is about being inclusive and creating opportunities for all community members. And the other thing that I learned and became very clear over time in Active Ottumwa, was about leveraging and uplifting the resources of the community. And I think also that’s another great thing about Active Ottumwa and the work that PRC does is we really think about okay, what are the assets, what are the resources, what makes proud the community and sort of how we connect that with behaviors and health promotion and really leverage that. And I think Active Ottumwa’s physical activity came from that place. Uhm, and activating leaders in the community, right, so we find a lot of leaders that they were able to, to help us disseminate and help us implement the program throughout the community and that was part of the, the social capital that Active Ottumwa had.

And then, again, like I sort of mentioned its sort of working in partnership but in also thinking about population health and trying to do the study at this, sort of, in terms of research thinking about implementation science and population health and really taking these strategies to the next level and really scaling that up right, and so to fulfilling the mission of population health and bringing this evidence that we, we have worked so hard for so many decades to accumulate, to actually produce the benefit that we were hoping. We would really want to be participatory, really finding a partner that wanted to sort of get in the weeds of doing research together, right so that was important. Opportunity to grow and to learn and serve a community that
needed so that was another reason. And we also wanted to sort of get, and we’re really good at that, in terms of getting outside our comfort zone and so for us it also was really important not to be necessarily within the sort of the bounds of the University by getting a little bit out there. So physically, geographically we’re far away from the University building, I guess right, not necessarily their presence. But it was a was a planned process. So, again, at that time, and that even preceded me to the time that I was in Iowa. Edith Parker, the Dean of the College, and other members of the PRC really met a lot of people throughout the state. So, I think we visited about 12 or 15 communities. They were away from Iowa City and the county and really talked to them through informal interviews and learned more about where they were in terms of their health promotion efforts their, their interest or the capacity to even engage in a process like this. And soon after many of those meetings was clear that Active Ottumwa was a great potential partner. And so we started talking to them and you know because, some of because of the disparities of the region so we’ve really acknowledged that there was an opportunity for us to may have a healthy impact, but also because that we, we found a strong, uhm, members in the community that were interested in, and on this same commitment right, so creating, I mean an advisory board is formed, or was formed, by 12 different organizations in the community. A very diverse group of organizations that stayed with us for seven years or something like that, right, doing the work. So that spoke really highly to the commitment in the intentionality of the work so that, that sort of ensured the story about how we landed there right, they welcomed us. They were willing to work with us and then that was what made a big difference.

Hannah Shultz: We heard Barbara talk about implementation science, and in public health especially we always stress the importance of evidence-based interactions. So now we’re going to hear from Becky and Barbara, about what evidence they used to design the intervention in a Ottumwa.

Barbara Baquero: It’s all about taking what we know works, and then trying to implement it and scaling it up and thinking about the population health, right. So we are funded by the CDC, so it’s a little bit different in terms of how do we move evidence to practice, kind of thing, right, and its less about these particular research questions that we sometimes want to ask. And so, Active Ottumwa was based in evidence so many years of many different studies and people start accumulating knowledge around how do we promote, how do we support people, individuals and communities, to be physically active. And so then the CDC, through the Community Guide, works to evaluate this evidence and they say okay this is good, this evidence is robust in terms of the scientific sort of value and the rigor, but also has value because we know that it has been replicated in many different settings or different circumstances, right. So based on that, and that was one of the requirements of our probe, the proposal that we put together, is that it needed to be based on this, this sort of compendium of evidence right. So basically what the, this evidence tells us for physical activity is that we should have media campaigns or informational campaigns to promote physical activity. That we should have strategies and activities at the social and behavioral level. And then we also should support all these, these potential activities through environmental changes. So think about the built environment, because we know that it takes a lot of different, it takes many levels of influence, right, so if you think about how we sort of promote behavior change, but also the community were ready to take on these many different aspects of getting everybody in the community to start to at least try physical activity and trying to be more active, right. So we decided, okay, we’re going to develop a, we’re going to create or tailor these practices, these group practices, as these different levels of influence for the context of Ottumwa. And that’s how we sort of started and made the decision together on how to, we already had that vision, I mean there was a very clear vision when we put a proposal forward and I think also again that’s one of the reasons why we were continued to be awarded to do the work. But it was that larger vision that we have for the population.

Becky Bucklin: We did take these, these different community guard principles and strategies that they had found in evidence-based literature to work for physical activity. And, again we did those all three different levels of the campaign information: all the behavior, all the social support as well as the environmental. But one of the cool things we did is we created this document that was tailored for micropolitan communities. Specifically, Ottumwa, at the time, called a menu of activities. And this menu of activities we printed out for our CAB members to, to look at but also they did contribute to it as well. So they made sure that that document was looking at these different evidence-based principles from the perspective of the Ottumwa community. And then we also, during our Physical Activity Leader training, which we’ll talk more about that later, which really became the heart and soul, I think, of Active Ottumwa along with Sandy who was our, our person who really got them coordinated and put together and really made the program work. So without the Physical Activity Leaders this program wouldn’t have flourished as it did. And so we also trained the Physical Activity Leaders or these people in the community who were interested in getting their community to be more active. We trained them in this menu of activities so they can kind of pick and choose. They didn’t necessarily do every single evidence-based principle but based on the resources that they had available to them and the things that they were interested in promoting in their community, they kind of picked and chose strategies that fit best within the Ottumwa community. And of course, one of the best things about that is that they can continue to grow and utilize other strategies, moving forward if they still want to. They still have that tangible document that they can utilize moving forward and see well, now that we’ve kind of gotten these, this social behavioral support strategy underway, why don’t we add this extra piece that’s also supported by the literature.

Barbara Baquero: When we pick physical activity and the evidence is very specific to oh, we started a walking club, or we had Zumba classes for everybody, right. So many of the programs that we’d review and taking consideration of were sort of recommended in the Community Guide, talk about one type of physical activity. And one thing that we quickly agree in our planning was that we didn’t want to sort of marry to ourselves to one activity, because that may also be, excluding some members of the community, right, so we want it to be about inclusion so it’s like, hey anything you want to do for physical activity, I just want you to be active, right, and so therefore why we have walking clubs, we had all these other things that Sandy can talk about, but I think that’s also one of the other beauties. It’s a beautiful program right that in terms of like all the sort of the flexibility that we have to really be inclusive, in terms of what it means to be physically active and who should be physically active, or everybody should be physically active.

Hannah Shultz: There are a lot of interventions that can be designed and implemented to improve community health, but the PRC and their community partners in Ottumwa use this evidence-base to choose physical activity as the right intervention in Ottumwa at this time.

Becky Bucklin: Physical activity is very interconnected to our mental well-being. And it’s also very connected to our energy levels, and our overall health. And so, in Iowa we did, we in 2017, a quarter of the state’s residents, said that they engage in no exercise or physical activity, other than what was required for their job. And so that’s why physical activity in Iowa or getting people to start moving in Iowa is important. And then, if people begin to be more physically active some of the benefits that they can achieve are reduced risk of many chronic conditions such as stroke, heart disease, diabetes, and certain types of cancer. Under the reduction in obesity lower blood pressure stronger bones, reduce anxiety and stress, getting back to that mental health and mental components of being physically active. And so just in general when you’re able to add some sort of activity to your life you’re able to find a better sense of overall health and well-being and so one of the great things about Active Ottumwa that I thought was, I think the most inspirational for me is that we weren’t going for the people who were super physically active. We were going for those people, that 25% of Iowans, who are not taking part in any physical activity outside of their jobs. So we’re trying to get people to start their journey of physical activity. Those people who are really struggling to just get going and get those first few steps in in a walking group. And so we are able to use the support of the, the Physical Activity Leaders, who are these people who are part the community who may have had struggles themselves beginning to be physically active. We’re utilizing their stories to move us forward and getting the individuals in Ottumwa who are really struggling to be physically active, to really start that physical activity.

Hannah Shultz: One of the important aspects of Active Ottumwa was having Sandy as part of the team. Sandy is a native Ottumwan and knows the community well. She also knows what some of the barriers to activity are in Ottumwa.

Sandy Berto: I have lived here all my life, and I have seen the good, the bad, and the ugly of Ottumwa. I think for physical activity, the biggest concern in people not being active, is the lack of social support. For me, I think, when you belong then you’re more apt to encourage each other in whatever journey that you happen to encounter. For Ottumwa, we have a higher poverty rate, so people just automatically cannot afford gym memberships. Several people working two and three jobs, working 12 hours a day, and if you don’t have that social support then you’re not likely to be able to continue in an organized physical activity. Also, I think that physical activity has been one of the activities that are hard to, not only be inclusive of other people, but then to be able to share with each other, to share with each other. I think, I think that’s, from my perspective, just being able to feel, be, feel welcome, to feel included, to be accepted as who you are, and wherever you are just like Becky stated. I think that’s just a huge aspect of it. And then also the PALs, or the Physical Activity Leaders, again as Becky alluded to, are the, they’re the only reason, in my opinion, that Active Ottumwa really was a huge success. I think they’re the cornerstone of the program. And also just the fact that they’re real, ordinary people. We had people of all ages, sizes, religions, races, that just made everybody feel very included. And I think in that inclusiveness, then, everybody just proceeded to share their journey. The ups and downs of them.

Hannah Shultz: Sandy has been very kind and very humble. Most of the people we talked to said Sandy was the reason Active Ottumwa was successful. This really underscores the value and importance of strong community partnerships.

Sandy Berto: I think the community at first really saw Active Ottumwa, as a threat that gyms and the, and some of the other organizations. But I think once they heard it enough from several people within the community, that Active Ottumwa is not always going to be in Ottumwa, so, we just want to encourage people to be active and then perhaps seek out the other organizations. So, I think they had to hear it several times that we weren’t going to, that University was not going to take over the physical activity, fitness places in town. Then, then I think we even had more cooperation from some of those other organizations, as far as donating space. The pool at the local Y.

Becky Bucklin: One of the coolest things I think about Active Ottumwa, when you go into when we first were in the community it is hard for some gym to really want a free physical activity model to come into their community and they think that it’s going to be competitive but actually we did have quite a few members and participants who once they again started that journey and they have some efficacy behind that they can actually be physically active they started wanting to do more. So they actually joined the local gyms, and they became more active through it. So again, it’s that like getting people to where they believe that they are the person that can be physically active.

Rima Afifi: As you know, as an all communities there are tensions between sort of a business model and a community engagement model. And where an organization, you know who has a business model related to physical activity might, might feel threatened I guess by a community engagement free model. When we can sort of present the, the success of Active Ottumwa exactly in the way that Becky said, that in fact, it may eventually bring people into the business model, so into a membership and the YMCA, then those organizations that perhaps may see it as a threatening model, indeed see how their role as community partners and their commitment to this community, which they also have, can be a win-win when they engage with an intervention process like Active Ottumwa.

Hannah Shultz: A key part of Community Based Participatory Research, as we’ve heard and, will continue discussing throughout this series, is true partnership with communities. With Active Ottumwa, researchers from the University of Iowa started talking with an engaging the Ottumwa community years before the intervention stage of the project even began.

Barbara Baquero: When you start establishing the partnership, finding our partners, and that’s to me the beginning of a relationship with the city and our collaboration, right, and it started at the end of 2012. So let’s do the math, it’s about eight years, right, and that was way before the grant. So I think one of the things that is also very exciting and it’s in a way, a privilege for researchers like us to, that are interested in Community Based Participatory Research, is that we actually had the time and the resources in a last cycle before Active Ottumwa to really spend time planning and building the collaboration and, you know, gaining the trust of the community implanting the new research project together. Which are many times that happens in the beginning of the project or sometimes you have to make some quick decisions and go for it. Here we had that privilege and that was, I know that doesn’t come often. So we’re really, really excited about that. So really, like I said the latter of 2012, it was just really about establishing the partnership, figuring our sort of rules of engagement and so on. And we started the planning of Active Ottumwa in 2013. We submitted our proposal to the CDC, I think in late 2013 or was spring of 2014, or something like that. And we got funded that same year in 2014. So in terms of the grant period, it was five years and started in 2014 and it worked until last year, October 2019. So I’m giving you all these, you know, sort of benchmarks in a timeline. In terms of the intervention our first year was more about planning and figuring out what we were doing. You know the first year of sort of funding for Active Ottumwa was about figuring out our office, for example, which was also very different. We actually had physical space in our name and the collaboration right on the main street in Ottumwa and that was also very important to us and that took a while to get there, right. And sort of, also, again, thinking about how the details of our intervention, right, of our program. The, the actual being out in the community and training Physical Activity Leaders and doing, actually executing the intervention plan and doing the program in the community it was almost three years, right, that they lasted in terms of from the beginning all the way to then. And then you know we can go into the details of the different parts of those three years but really, as a whole sort of from the beginning to them we were working out and supporting and in promoting activities in the community for about three years. Right, so the different levels of intensity and different levels of intentionality, too, in terms of who are we talking to, you know, what are their focus. And then the last part of, I guess, last year was more about sort of processing all the things that we have done and the information and really getting ready for the next version of Active Ottumwa, which is Active Iowa.

Hannah Shultz: You mentioned that Active Ottumwa is coming to an end at least with the PRC’s involvement so that we can refocus on Active Iowa, a more statewide campaign with a similar approach. So can you talk a little bit about what’s happening with Active Ottumwa now?

Barbara Baquero: You know, sort of, we’re always going to be there right, I don’t know, maybe the direct and active engagement of the researchers of the partnership, but Active Ottumwa continues right and that is also a wonderful outcome of the program, I think.

Rima Afifi: I think it’s really important to say that we, our partnership with Ottumwa was very important to the College of Public Health and we hope that it continues for a long time around physical activity and around other issues that come up in Ottumwa so that we are communicating and supporting each other in the various skills that we all have. So part of the sort of community participatory approach is an acknowledgement that everybody is an expert, and everybody has skills that they bring around the table, and that this is a partnership, and that it can’t work without everybody’s involvement. Part of the reason that we engage in community participatory interventions, is that this project started off from a grant proposal and grants come and go. Sometimes they stay longer sometimes they stay shorter, but the whole point of a partnership, and learning together, and co-learning about everything, is when the time comes for the community, the funding to potentially not be available to do the same amount of on the ground work that we’ve been doing for the last five years, there’s a clear transition point in the sense that the community that’s already capable of engaging in this work can sort of go on to continue the program, even if the university partners aren’t as actively involved on the ground despite the fact that the commitment and support to the success of that program, occurs. So the Community Advisory Board, one of the key points of that, is that again we’re all learning together about how to do this program and specifically how to do this program in Ottumwa. And the CDC funding allowed us to work very very, in a lot of depth in Ottumwa for those five years that Barbara was talking about. And at the same time also transition the program so that the community of Ottumwa could take it on and continue the program, because it was successful for much longer. So as part, in that last year of confirmed funding that we had from the CDC we worked very much in partnership with the Community Advisory Board to think about where might this program possibly be housed, quote unquote housed, once it transitions into the community. And there was a lot of discussions with a lot of potential entities in the, in the community. And one of those actually panned out, although I think there were several that were possibilities, but it just works sort of, all of the, all of the sort of everything fell in place with Hy-Vee. So Hy-Vee has a nutritionist that’s committed to sort of nutrition and physical activity that had the time to commit to this. Hy-Vee as an organization was committed to this. And so we began the process, and Sandy can talk and Becky can talk a lot more about this, of transitioning the project to Hy-Vee. Keeping it otherwise the same, so the same Physical Activity Leaders are involved, the same, you know, it’s the same program. It’s just that it’s, quote unquote owned by the community and a specific organization in the community, rather than owned by the community and the Prevention Research Center in a sense. And so that was part of how that transition happened to Hy-Vee. Now you know the nice thing about the transition to Hy-Vee is once Hy-Vee in Ottumwa, you know, takes this on and is confident in the program and the rollout of the program then Hy-Vee as you know is not only in Ottumwa, its across Iowa and its across many states. So there is potential for that to also scale up to other Hy-Vees and benefit many more other, more communities.

Hannah Shultz: One of the wonderful things we’re going to hear throughout this series is how passionate people in Ottumwa are about this program, and the commitment everyone involved has to keep it going long after the university’s official involvement ends.

Barbara Baquero: I don’t know that we understood the, we couldn’t imagine how sort of impactful it was going to be, you know, in a way. We sort of have in theory, thought this is the way it’s supposed to work and part of, and also part of our intention was that we developed something that can be sustained right without us. So from the beginning we knew that this, because you know we know how funding worked for us and also our partners understand that because there are organizations that are in many cases based on sort of funding cycles as well. We knew that this needed to be something that was realistic for the community, that it was realistic for us to support. And, and that could be potentially sustained, right, because of the potential impact that we have. So, again, I think that that is also one of the lessons learned from this process. Is it possible to design a program based on evidence, but also design it to think about it long term and sustainability? And it may continue to change, right, and now there’s different organizations that are hosts and it might be a new group of people and they might decide you know what we want to do just one kind of physical activity. But as long as it continues happening, the branding is out there, the social norms for most are changing right the expectation is that we should have this in our community we deserve it, we can do it. I think that that’s the goal right, and then that’s naturally how things progress in the community.

Rima Afifi: Part of the community participatory approach is this idea of sustainability. So you know as Barbara described, you know we were in the community two years before we actually applied for the grant. And that was all about building partnerships, talking to each other, understanding each other, and figuring out what the priorities and needs were in the community. As opposed to another approach where quote unquote perceived experts come in and decide for the community what those needs are. And a community participatory approach, because it’s engaging, because we’re trying to listen to all voices, because we’re learning completely, I mean it’s the total co-learning process with nobody assuming that anybody knows better than anybody else. We all know something that gets us, thar moves us forward. It does take time, but in that time and in the building of the relationships, there’s much more understanding of the fact that people have the same overall goal and mission in mind which is, you know, uplifting health, promoting health and well-being in communities. Whatever way that is defined in those communities. And therefore, there is much higher chance that that will sustain because everybody has been engaged from the beginning. And so that idea of sustainability is something we talk about from the very beginning. That this is part of a process that we’re engaging in together that we hope is a long-term process.

Hannah Shultz: Barbara has a great story about co learning and the importance of trusting that the community knows itself.

Barbara Baquero: So, I think, it exemplifies that experience of the co-learning, right. So, at one point maybe year two were like starting up, wrapping up, Becky’s ready to get everybody out active in the community. And we haven’t set a little bit, I think was maybe right before, Sandy, or the beginning of Sandy, so she was still learning what we should do in there right. And we had a hard time keeping the Physical Activity Leaders sort of engaged and they didn’t even know what exactly we’re doing so we were like, we need to get this going right we know we’re ready. And we sort of look at other models and in other states similar to the PRC and to Active Ottumwa, and they were paying Physical Activity Leaders actually, for per class, so for people that they were showing up, right, in the physical activity classes. So, we brought some ideas where compensation was part of the equation, I guess, you know in terms of, there’s some compensation and some support for the Physical Activity Leaders where it’s more about doing the activities right. Anyways, the short story is that we didn’t make that decision ourselves. We went into and met with our partners to our community advisors and said look this is what’s happening. We think maybe if we do a little bit more sort of like individual incentive that may work better and then, you know, sort of, we’ve removed some of the barriers that they might have, And the advisory board said no, we want this to be sustainable and we know that if we start paying people now it becomes a job, and we might not end up with the right leaders. Or we’re not going to have this money when you guys are gone, right, and they told us that very plainly and I think that came from the trust that we had built, because they understood what we were trying to do. And I think it was really hard for us and we had like two hours on our ride back to sort of be okay and trust that the community knew better, right. We brought the evidence. We told them these are some strategies, it’s like no, let’s try it and if it doesn’t work then we’ll figure out something else. But we want to make that happen and I think to me that’s one of those key moments in the, in the life of Active where like, yes, we need to trust the community. They know better, and things worked out, right. So, we got the right people and so on. And it took a little bit more time, but they were willing to go slower. Maybe you know let’s figure out what happened with this model, and instead of sort of running back in, in you know, in a traditional space where I might have paid people because I just needed the intervention done. So that was one huge lesson that I learned in the process and again I was grateful that we had that opportunity to do with them.

Hannah Shultz: One of these right people was Sandy Berto, who is brought in really early on and was a strong bridge between the University and Ottumwa.

Becky Bucklin: Sandy kind of came on board at the same time. And then Sandy became the key as to why the Physical Activity Leaders were able to sustain their activities because Sandy really put her love and energy into this. But with the Physical Activity Leaders when we actually transition to Hy-Vee, we had a strong group of Physical Activity Leaders who trusted the program, who had bought into the program, who loved the program, as well as all these materials that we’ve created to give to Hy-Vee to use as much as they wanted to use. So all that like background work of actually designing and getting the community behind it was done through our project, but then Hy-Vee was able to kind of bounce off that and really kind of hit the ground running with a new coordinator. But we did find out, even though we didn’t pay them, the coordinator was the key. And so, they still do have a coordinator at Hy-Vee who’s the dietitian there.

Rima Afifi: Although we’ve talked a lot about how we think that a community participatory approach is the way to go, it cannot be done if somebody doesn’t truly believe in the community participatory approach and is committed to letting go of any power, that we may perceive we have, whether we’re coming from academia or some organization, etc. So I urge people not to take up community participatory approaches just because they think they work if they don’t truly believe in the power of partnership and are truly willing to get rid of all perceptions of being the only expert in the room.

Hannah Shultz: So Sandy I’m curious what your experience has been and working with the partners in Ottumwa and being, in many ways, the bridge between Ottumwa and the University of Iowa.

Sandy Berto: I’ve always been a connector. I love people. I like to talk. I build relationships with people. I have people approach me in the grocery store about what to buy, and I don’t even make eye contact with them. Honestly, I think it’s, anybody can do it, but I think you have to, to just be warm and welcoming. Because Active Ottumwa, if you just think about an old-fashioned wheel, you know I’m just kind of in the center, but the PALs are the spokes that really makes it go around. I just happened to be so fortunate to come on to the team. And I know a lot of people in Ottumwa from living here all my life. And I think in those various jobs I have made some of those connections. So, I may not always know somebody who’s the right person for an answer to be, or a question to be answered but I know somebody who might know somebody.

Hannah Shultz: We spend some time talking about the importance of sustainable relationships, and the strength of Active Ottumwa, that individuals can leave without the coalition and project falling apart. As the coalition of Active Ottumwa transitions to Hy-Vee, the strength of the relationships built over the last eight years are shining. Throughout this series we’re going to talk about many aspects of Active Ottumwa and will at times hint at Active Iowa. As we are recording this series during the COVID-19 pandemic, the details of how Active Iowa will launch are still being ironed out, but we did ask Rima to talk to us a bit about the evidence and rationale for scaling up Active Ottumwa.

Rima Afifi: Since we were trying this out in or adapting it to a micropolitan community then we want to scale it up to other micropolitan communities. We want to say this works in Ottumwa, can it work in other places. So that’s part of the transition from Active Ottumwa to Active Iowa. We are trying to see if we can get other communities in Iowa that are micropolitan to actually be interested in trying to implement this intervention, right. But in Active Ottumwa, the PRC faculty and staff were funded to sort of carry out a research project in partnership with community to implement and evaluate the intervention and that’s important to get the evidence out there. But once the evidence is clear, then the model of an academic institution leading implementation is not very cost efficient. So, what we want to do is see what does it take to get organizations within that community to actually adopt this intervention and implement it themselves. So in the scale up of Active Ottumwa to Active Iowa we’re trying to find, to turn over this intervention to agencies that are existing in the community and for whom the focus of the intervention as a goal. So, in physical activity we’re trying to find organizations for whom promoting physical activity is a goal. Those could be health organizations, they could be physical activity organizations, or other types of organizations. So as we move forward, the current research project or research, the core research project of the PRC is Active Iowa and our role is to assess what are the best strategies to provide support to organizations, so that they can take on this intervention, and they can implement it themselves in their own communities. So, we’re going to be working with organizations and several micropolitan communities across Iowa to provide technical assistance and training for them to be able to implement the intervention. And our role isn’t an implementer rather a facilitator to the implementation process that other organizations will engage in. Now just sort of a final thing is to facilitate that process we’ve worked very hard to develop a detailed manual of implementation and Becky’s been a key part of that. And the manual of implementation describes the step-by-step process of one, the evidence, and then the steps needed to implement the intervention based 100% on the experiences with Ottumwa. So Active Ottumwa lives on. It lives on in the manual of implementation, as well as, as a particular intervention project in the, in the city of Ottumwa. So the new research project is called Active Iowa, and it’s trying to scale up Active Ottumwa to other micropolitan communities.

Barbara Baquero: And so we also built time in our Active Ottumwa timeline to plan for the next project, right. And the voice again, of our community partners were really strong in figuring out what that would look like. Through like the decision of going Active Iowa was made together, right. The decision of let’s bring this that is valid, that we feel so proud about from Ottumwa to the rest of the state. We’ll show, we did it so can you do it, right. That was also an idea that came about with our community partners, right, so we just sort of added the research component in there because that’s sort of part of our mandate, but it’s really again informed by what the community says that yeah let’s take this bigger. Let’s go statewide, right. So, I think that that is also, that’s been very intentional about that process. And some members of our Ottumwa advisory board or community partners are now part of the larger PRC and Active Iowa advisory board, right. So, the historical knowledge and the continuity persists, right.

Rima Afifi: So, I think that the key point about Active Ottumwa, and we’ve sort of said this, is that we started off with an evidence-based intervention. So we started off with something that had evidence of effectiveness in enough places that could be called an evidence-based intervention or something we call EBI. But we were, we were adapting it and if you recall, I said that was one of those sort of focus areas of the PRC, we were adapting it to a place that it hadn’t yet been tried, so this micropolitan community of Ottumwa. To see if, does this program that has some evidence from potentially urban areas, does it also work in micropolitan communities, and if so, how does it work. What are the core strategies that make it work in a community like Ottumwa. And when I say there was evidence, it means we found improvements in physical activity at the population level. So that’s excellent right because we definitely would not take an intervention that didn’t have evidence and try to scale it up. But if there is an intervention that does have evidence and evidence related to a behavior that has serious health consequences. So lack of physical activity causes a lot of health problems that therefore we do want to do something about physical activity. Once we have that evidence, then we can think all right this is wonderful. How is it possible to scale up this intervention, and by scale up we mean take it to communities beyond one community. Take it to other communities.

Hannah Shultz: Over the course of the next nine episodes we’ll learn more about what made Active Ottumwa successful and how that evidence and learning will be scaled up to Active Iowa.

Thank you for listening. I’m grateful to Becky, Sandy, Barbara and Rima for joining us and sharing what Active Ottumwa is and how it got started. Please stick with us through all 10 episodes to hear from Physical Activity Leaders, Community Advisory Board members, and community participants of Active Ottumwa. Thank you for tuning in. Thanks to the Midwestern Public Health Training Center for production support, the team at the University of Iowa Prevention Research Center for Rural Health, the Ottumwa community, and the many guests and contributors we talk with throughout these 10 episodes. See the podcast notes for more information about Active Ottumwa, and to connect with our team. This podcast is a product of the Health Promotion and Disease Prevention Research Center, supported by cooperative agreement number of U84DP006389 from the Centers for Disease Control and Prevention. The findings and conclusions in this podcast are those of the contributors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.