Table 2 Key quotes from emergent themes

Developing a nuanced understanding of their communities

That was something that’s unique, I think, to this area, the trails and—because it is such a pretty area and then the lakes I think—which I don’t know that you could transfer that to another area, but I think the lakes bring a certain mindset about wanting to get out, and be in your swimsuit, and be on the water, and you’ve got to be somewhat physically fit to feel comfortable doing all that.

This is just the way we’ve cooked for 20 years and it’s been handed down generation to generation. My great grandmother didn’t know that cooking in lard was not healthy, that’s all there was. It’s a new education for that generation saying, “Okay, you can still have this great food, but let’s try warming it up in the microwave instead of frying it in lard to warm it up.” There’s different methods.

Recognizing the complex nature of obesity

Overall, I think that the big take away… is giving people permission to say… my barriers may not be your barriers, and they might be emotional or they might be access or they might be economic or they might be education. Unfortunately, the problems are not easy, but we can facilitate cultures where people can find their own answers. When we do that, then I think you see success.

We’re going to find out that it’s not just going to be any kind of food or physical activity, or any one, or even set of things necessarily focused on obesity or physical activity and nutrition, that’s creating a difference. I think you’re going to see it’s a real sweep of initiatives and social service movements that have combined.

Developing a countywide strategic approach for promoting healthy living

I think that I mentioned earlier the backbone organization, having a backbone organization that the community considers somewhat of a neutral convener. … I think at least in this community, what [we] brings to the table is a responsibility and a focus on the entire community… but having somebody, some organization who thinks of population broadly and is not necessarily a heavy provider of service. I’m not competing with anybody. I mean my job is to bring them all together and try to figure out how to help them work better together. It’s not to compete. I think that plays a big role and I think that you can’t convene something then expect it to run on its own. It takes tending and feeding and all of that to keep it moving forward.

Break down silos and build partnerships

I really, strongly believe that we’ve been working in our silo in the community on issues and we’ve been working in our silos in practices in medical community so they’re wanting us to improve health outcomes and reduce costs. If we keep working in our silos, although we might work a little bit differently, we’re not going have the impact we want. It’s got to be a comprehensive look.

The goals are just different and you need to find that middle ground to where you can both say, “Okay, we’re both going to win from this,” and make the best of the situation and still find that audience that we’re looking for and get the message to them that we need to get to them.

We have a AAA baseball park that just opened here recently. We were approached by them. We weren’t looking for the partnership, but they said, ‘We want to do what we can in our concessions to have healthy options for children. We heard about you guys. We want on board. What can we do?’ Not a conventional partnership, not something you would think about. Eating healthy is definitely not the ball park. You go to the ball park to eat junk and have fun and drink beer and watch a game.

You just, I think, at a community level need to be open to unconventional partnerships and not be scared when somebody in the community approaches you about wanting to do something about obesity. You need to be willing to be flexible, and be adjustable, and think outside of the box on—it can’t be an automatic no. It needs to be, “Let’s sit back and think about this and think how we can work together.” It may not be something that’s traditional. It may be something off the wall and out of the box, but let’s try it and see what happens. I think some of our best partnerships have happened that way.

Tap into community resources and foster connections

The other part of [successful interventions] is we all [community leaders and community members] have to own it. It doesn’t belong to anyone in particular and as long as it doesn’t belong to anyone in particular and no one in particular is trying to take total credit for it and everybody is getting their share of the credit, that’s another reason for people to keep coming to the table.

We spread ourselves a little thin for a while there and were doing so many different things that we couldn’t sustain that for too many years, and so kind of pulled back and started thinking more strategically and put a lot of efforts into, for example, this strategic plan that was designed to, okay, if we’re going to really do this over the long-term, let’s have some very clear goals for where we wanted to move towards.

Transferring ownership to the community members

We had a small number of extremely dedicated people…. We had these community advocates, and so those ringleaders, if you will, that were really critical for our efforts to be sustained over the longer term… Without that infrastructure, it just, at some point we just felt like we were spinning our wheels and no one had enough time to dig in and to say, “Okay, how do we prioritize the things that we need to do and how do we get the investment of, say, our city council and so forth?” Even with the very best of intentions and some pretty good energy, those kinds of efforts are really difficult to maintain over the longer term, and so it really does require an infrastructure that has some funding or that has the possibility.

That’s the key, is to be able to measure and report out successes on a regular basis so that people are feeling like we’re making progress as long. As we’re making progress, people are going to be willing to keep coming to the table and the resources from the county for us to do this work will continue and the interest of funders of strategies that we’d like to do in the community will continue, but you have to be able to show the successes. I think that’s a key part to sustainability.