Characterizing implementation strategies and behavior change techniques used by Rhode Island Health Equity Zones to...

Chronic diseases are highly prevalent and driven in part by modifiable behaviors including diet and physical activity. Most US adults do not meet behavioral guidelines. Rhode Island (RI)'s 14 Health Equity Zones (HEZs) address chronic disease through place-based efforts to support healthier behaviors statewide.

To characterize the strategies used by the RI HEZs to implement programs to improve nutrition access and opportunities for physical activity.

Annual process evaluations from RI HEZs were reviewed using retrospective content analysis to categorize HEZ implementation efforts related to improving diet and physical activity. Activities were coded using the established Behavior Change Technique (BCT) Taxonomy v1, and Expert Recommendations for Implementing Change (ERIC) strategies.

In each HEZ, 0-62 BCTs and ERIC strategy instances were used to increase physical activity or improve nutrition access. Coding identified 30 out of 93 BCTs and 33 out of 73 ERIC strategies. The most frequently coded BCTs were: Restructuring the social environment (n = 40), social support (practical) (n = 35), instruction on how to perform a behavior (n = 33), adding objects to the environment (n = 22), and restructuring the physical environment (n = 12). The most frequently coded ERIC strategies were: promote network weaving (n = 49), build a coalition (n = 23), access new funding (n = 20), develop resource sharing agreements (n = 18), and tailor strategies (n = 14). HEZs used BCTs and ERIC strategies primarily to implement programs to reduce food insecurity, increase access to nutritious foods, and support physical activity opportunities.

HEZs utilized social-driven BCTs and ERIC strategies to provide accessible nutrition and physical activity programming. Results inform strategies for future community-driven chronic disease prevention efforts.