Increase Healthy Beverage Consumption and Reduce Sugar-Sweetened Beverages (SSBs):
A Community Roadmap
1
Community Assessment:
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2
Identify Stakeholders:
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3
State Your Purpose:
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4
Choose Pathways:
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5
How Did It Work?:
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View Water First! Community Stories:
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Community Assessment:

Community assessment can help you understand what’s important to your community. You can also identify strengths, assets, needs and challenges to making the journey from SSB consumption as the norm to making water the first choice drink.

The first three steps, Community Assessment, Identifying Stakeholders, and Developing a Statement of Purpose, will probably be iterative activities as you explore

  • Community’s readiness for and acceptability of an intervention to make change
  • Goals for the intervention
  • Community assets and strengths that will aid the intervention

QUESTIONS TO ASK:

What does your community see as the challenge? What might motivate people in your community to move from drinking SSBs to drinking water?

There is a number of reasons to be interested in this work, including

Health

Tradition

Environmental concerns

Compliance with regulations

Cost

Here are some other questions to ask:

  • What are the strengths and assets of the community?
  • What are the challenges your children face with regard to health issues?
  • What are the primary barriers to eliminating the consumption of SSBs among children in your community?
  • How does the community view the consumption of SSBs?
  • What policy or systems changes are needed?
  • What are the primary barriers to eliminating the consumption of SSBs among children in your community? What are the barriers to change in your community?

TECHNIQUES:

Next, think about who you want to gather information from and how you should do it. You can use NB3 Foundation's Community Assessment “Strategic Map” and overview to help you organize your process.

Also, consider using a range of different tools and methods to gather information. Here are some ideas:

Focus groups can be a great way to capture your community members in conversation about these issues.

  • Pros: can capture deeper and more nuanced information
  • Cons: can be tricky to schedule, need to develop questions and train group leaders

A survey can be a good way to gather targeted information from a large group of people. You could do an intercept survey, where you are interviewing random people at a store, school, community event, etc. Or you could survey all the participants in a program, the parents at a school or childcare site, etc.

  • Pros: Can gather lots of data quickly, can ask targeted questions, can use already-developed survey tools
  • Cons: Responses may not provide context, doesn’t allow for deeper conversation with participants, community members may not want to participate in a survey.
  • Community Outreach and Patient Empowerment (COPE) of Navajo Nation created Rez Cafe (adapted from World Cafe) to elicit community input. The purpose of “Community Rez Cafe” is to invite, involve and listen to community members in the Community Wellness Planning process. It is a fun and interactive way for community members to have a conversation about what matters to them.

Plan ahead: how will you measure change that comes about from your work? Be sure you use assessment tools that will capture the impact (outcomes) of your intervention. For example you might measure change from before to after the intervention in:

  • Knowledge and beliefs
  • Practices
  • SSB purchase or consumption patterns
  • Water purchase or consumption patterns
  • Health markers
Notes

Barriers cited by Summit participants:

Taste/flavor:

Used to sugary taste, water has “no flavor,” sugar addiction, school lunches come with milk, issues with water palatability, water isn’t clean and doesn’t taste good, water is boring; no “flavor” in water, no variety in healthy beverages, “no flavor”

Economic:

Cost of bottled water vs. SSBs, loss of revenue to stores, use of SNAP to buy SSBs, eating and drinking healthy is more expensive, soda is cheaper, in-home “snack shop” SSBs sales; costs; soda is cheaper (for gatherings), soda is cheaper to buy; sugary purchases with SNAP money; soda is the money-maker, funding/investment in change

Societal:

Social meaning of providing treats/gifts, sodas are expected at every ceremony and family gathering, SSBs is the normative drink, “Who wants to be the sugar police? Not me!;” “our community has suffered so much already, soda is one of our pleasures;” social-cultural norms (family, ceremony, gatherings, TV and media) all expect SSBs, SSBs are easy to access everywhere; fast food is all over, SSBs is ingrained behavior, soda is easy, soda is more fun than water; SSBs used as a reward, SSBs is easily available; life is too fast-paced to slow down and think about what’s good for you; serving SSBs not water is a traditional status symbol. funding, capacity, lack of interest in issue, pushback from community; SSBs is the norm, accustomed to SSBs at gatherings and unhappy when they are not; for kids: water bottle privileges taken away, water fountain is only access; lack of policy

Safety:

Contaminated water, limited access to clean water/unsafe well water, poor access to quality water, distrust in water source/non-palatable water; water access and water quality; water is contaminated

Health:

People are in denial, “it’s not a big deal” to drink SSBs, soda thought of as “good” energy source, “not ready for change” attitudes, lack of communication/understanding of long-range goals for health and wellness

Identify Stakeholders

The Collective Impact model suggests that you can make change most effectively by Identifying the organizations and individuals that need to be on this journey together.

QUESTIONS TO ASK:

What does your community see as the challenge? What might motivate people in your community to move from drinking SSBs to drinking water?

There is a number of reasons to be interested in this work, including

Youth can be powerful leaders or stakeholders. Here are some examples of youth-led projects

What are ways to identify potential stakeholders? There are a variety of ways you can identify potential stakeholders:

  • Use the “Snowball” approach, where one contact leads to another - you ask each person you speak with who else you should be talking to
  • Build collective impact - in this method you attempt to convene everyone who touches on the issue area and then find a common agenda - a core value you all agree on
  • Start with a local champion - reach out directly to local champion(s) in your community - people like Grandmas, medicine man, sports figures - people whose input will be valuable and whose support will help elevate your project
  • Finally, think of creative partnerships. In California, RCAC, a rural development and advocacy organization has partnered with a foundation and local community and tribal organizations throughout California to improve water access in schools. Read more about their work here

It’s also important to think about how best to tell your story, how to share the goal you’re working towards, and how to bring others into your work. Below are two resources that can help.

SKILL-BUILDING:

Project sharing: Telling about your program

  • Tell your story: that’s what people remember.
  • Learn how to tell your story through the Engage for Equity “River of Life” method

RESOURCE LINKS:

State Your Purpose

  • Ultimate goal: SSB consumption is decreased and water is the first choice drink
  • Reflection: how does the purpose respond to your community assessment?

RESOURCE LINKS:

A survey can be a good way to gather targeted information from a large group of people. You could do an intercept survey, where you are interviewing random people at a store, school, community event, etc. Or you could survey all the participants in a program, the parents at a school or childcare site, etc.

Choose Pathways

Many paths (strategies) move you to the goal - Which might work for your community? How do the strategies respond to community priorities and what your data revealed? What do you see as the feasibility and impact of your potential strategies?

This “pathways” section helps to organize your work into three overarching steps: drinking water safety, access and education/promotion and provides a menu of ideas and examples for strategies and activities your organization can take on.

Three overarching steps to build consumption of water:

  • Confirm safety of tap water
  • Improve access to safe and appealing water
  • Educate about and promote water
  • Each of these can be supported by policy
Safety
Access
Education, Promotion
Water: “First for Thirst”
Policy
  • Understand the context (“landscape”) in which you intend to make change. Use the results of your community assessment and input from your stakeholders to guide your choices.

First, understand water safety and water quality:

How does your community receive its water? What services do water and sewer utilities provide?

  • Basic Learning on Water Treatment and Water Distribution
  • Understanding where source water comes from, water treatment, and water distribution. Addressing concerns with water contamination, infrastructure deficiencies, and aging plumbing systems.
  • Traditional Water and Well Water Safety (Unregulated drinking water)
  • Potable vs. palatable
  • Water can be technically safe yet still not be appealing to drink because it has a smell, color or taste. It’s important to know what issues you are dealing with because that will drive the solutions.

Next, improve access to safe and appealing water:

Effective access means water that is safe, appealing, and easily accessible.

  • Effective access means water that is safe, appealing, and easily accessible.
  • This factsheet illustrates what that looks like in a school setting.
  • This infographic illustrates effective access in a park or other community space
  • Promote use of reusable water bottles
    • Choose the kind of water provision that matches your community’s needs. Be it bottled, filtered or tap: Any type of water is healthier for you and for the planet than SSBs.
  • Understanding your needs
    • Potability: Filtering can remove contaminants
    • Palatability: Filtering can improve flavor
    • This guide from EPA can help you choose the right filter (if needed): Guide to filtration levels and effective filtration practices

If improving tap water is not feasible, what are more sustainable and cost-effective means to access water?

  • Purchase water in 1 or 5-gal jugs, not 4-8 oz bottles. Talk with your dental care provider about getting enough fluoride for dental health.
  • Home filtering devices, e.g., Brita pitcher or dispenser
  • Community filtered water stations
  • STAR School, on the Navajo Nation, built their own portable water filtration unit
  • Navajo Nation communities installed filtered water-bottle filling stations (COPE, Ramah)

Then, support safe water access with strategies to encourage consumption:

Policy Strategies

Some policy involves major policy change. But “little p” policy can be very effective when you use it to change an organization or site-specific practices

“Big P Policy” - legislation

  • Is your community ready for a Soda or Junk Food tax like the Healthy Diné Nation Act?

“Little p Policy” - local or institutional policy development

  • Develop a Wellness Policy
  • Create a beverage policy for your organization or site

Drinking Water Education and Promotion Strategies

Pairing improved drinking water access with education and promotion can help boost consumption.

Your community assessment may have helped you to understand gaps in knowledge and beliefs. Perhaps messaging addressing water safety concerns and perceptions is needed. Or perhaps general nutrition education is key. The most powerful messages often combine pro-water messaging with anti-SSB messaging and education.

What should you say? How should you communicate it?

What do you want to say to promote water?

Nudges, prompts and messages can influence consumer choices. Marketing strategies make water more visible and/or make SSBs harder to find.

With enough community demand or store-owner buy-in, you may be able to change the marketing of beverages to highlight water, for example by asking for:

  • Placing water at eye level
  • Changing display cases to hold more water and fewer sugary drinks
  • Displaying water promotion - like a poster from a campaign
  • Placing water at end caps and/or by the cash register.

RESOURCE LINKS: Using the right words.

How Did It Work?

Evaluation

All peoples have done record-keeping - it’s in our heritage and history to keep records - notching, songs, traditional stories - are all ways to gather and pass on learnings.

Questions to ask:

  • How can we include Indigenous measures of change?
  • How can we capture not only the numbers but also the spirit that reflects the intervention?
  • What data will be important to your community?
  • What reporting is required by the project’s funder -- or will help us gain future funding?

Evaluation methods should be built in to your planning from the beginning, especially since you will want to measure how beverage behaviors were before and after your project or intervention.

Using Indigenous and Western measurements of impact. How can your program impact, and be impacted by, each of these levels of knowledge? Not every program can include every part. But every program can have awareness of these different types of knowledge and of assessment, can use these lenses to reflect on goals, activities, actions, and outcomes.

Components of the Western “ecological model”:

Individual level speaks to the grounding of work in an individual perspective - owned experience - and an awareness of the individual’s biases, understandings, relationships, and assumptions. In this space, an individual can assert personal agency and choice.

  • Example: how the program impacts an individual youth.

Family level refers to familial connections and perspectives - e.g., school to home and home to school learnings. In an Indigenous framework, this may also include not only biological family only but also clan, kiva, society and extended family connections. This level represents those who are closest to the individual and have a strong influence on the individual’s actions and reflections.

  • Example: how the program impacts youth on a family level and how the program can help youth impact their family.

Community level refers to the community in which the individual and family reside and/or are most closely associated. The community dictates norms and values and can have a powerful influence on the individual through the framing of meaning and value conveyed in cultural and traditional understanding.

  • Example: how the program impacts community youth, and how the youth can impact their community; finding inter-generational commonalities (including service learning, after-school programs (and places to go); building community interest, participation and enthusiasm.

Indigenous Thinkings:

Creation level includes all that exists before and beyond the community, what binds everything together. Creation refers to all the spiritual and physical interfaces amongst the ecology, the environment, the community, the family and the individual.

  • Example: how the program helps youth learn from creation (what is in existence) and to create (put things into existence; be a change-agent).

Holders and Carriers of Language and Culture, Stories, Ceremonies, Meaning and Relationships (stories, traditional practices, habits and beliefs; what is the core or heart-meaning of the work?). These contribute to a community’s identity. In the modern western models, the individual can determine his or her identity in isolation, choosing to be whoever he/she wants to be. In Indigenous cultures, a person is defined through relationships to family, community, and creation. These relationships define roles and responsibilities, reflect the individual’s place in his or her world, and help to define an understanding of health and balance.

  • Example: how the program impacts youth with relationships, language, culture, stories, or ceremonies and, vice versa, how the program can help youth impact these traditional practices and stories.

Indigenous Domains of Knowledge: what are the forms of “Indigenous” knowledge - traditional, spiritual and empirical learnings? Indigenous knowledge engages a holistic paradigm that acknowledges the emotional, spiritual, physical and mental well-being of a people. The cultural diversity of Indigenous peoples is addressed through the recognition that Indigenous knowledge is attached to the language, landscapes, and cultures from which it emerges. Traditional knowledge emerges from stories and cultural engagements as passed on through multiple generations. Empirical knowledge is learning through observation and experimentation. Revealed knowledge is that which is gained from prophecy, dreams or spiritual revelations (and can be deeply intuitive, elusive and difficult to explain without traditional or empirical explanations). What is the traditional way - and why or how did it change? What could modeling or observation teach us - or could teach us - in our program’s work? How can we make use of these Indigenous ways of knowing? What would be the impact on our youth?

  • Example: what do you sense or feel?