Family-focused obesity prevention program implementation in urban versus rural communities: a case study

Colleen Flattum, Sarah Friend, Melissa Horning, Rebecca Lindberg, Jennifer Beaudette, Jayne A. Fulkerson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. Methods: This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. Results: Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. Discussion: When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.

Original languageEnglish (US)
Article number1915
JournalBMC public health
Issue number1
StatePublished - Dec 2021

Bibliographical note

Funding Information:
The authors wish to thank the children and families who participated in the NU-HOME study. The authors are also very appreciative of the following interventionists and support staff for their expertise and professionalism in intervention implementation: Kate Callahan Schmitz, Rachel Jones, Shawn Hildebrandt, and nursing students from the Minnesota State University at Mankato. Thank you to the generosity and flexibility of the New Ulm and Sleepy Eye School Districts Superintendents for their support of the study and use of the school district facilities. We also thank the following research team members and student volunteers who contributed to the study: Jennifer Linde, Daheia Barr-Anderson, Abbey Sidebottom, Lori Rathburn, Yazmin Cespedes, Jessica Ramos, Christie Martin, Eydie Kramer, Sam Sommerness, Stephanie Grace, and Amanda Folk.

Funding Information:
This study was supported by National Institutes of Health (NIH) awards 1R01HL123699 (National Heart, Lung, and Blood Institute; NHLBI) and UL1TR002494 (National Center for Advancing Translational Sciences; NCATS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NHLBI, the NCATS or the NIH.

Publisher Copyright:
© 2021, The Author(s).


  • Children
  • Community
  • Intervention
  • Obesity
  • Rural

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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