A qualitative assessment of Charlotte REACH: an ecological perspective for decreasing CVD and diabetes among African Americans.

An ecological perspective of health promotion was used as the framework for a Charlotte community-based intervention to eliminate rates of health disparities in cardiovascular disease and diabetes. Interventions are targeted on 5 levels of influences, with interaction between levels creating a supportive system for sustained change. The purpose of this qualitative assessment was to explore changes that have occurred among and between the following levels of influences: intrapersonal, interpersonal, organizational, community, and policy. Data from 10 focus groups were analyzed to identify overarching themes and subthemes. Results support positive changes within and between levels of change. REACH participants reported an increase in knowledge of preventative health behaviors, the development of health-related skills, and the diffusion of knowledge to family. Fellowship was identified as the primary motivator to continue positive health behaviors. Community Lay Health Advisors (LHAs) reported changes in individual health perceptions from disease-to prevention-oriented, and positive community changes, including the establishment of walking groups, and a farmers' market. The REACH program staff reported that collaboration between staff and LHAs was crucial to program success. The results of this assessment provide feedback for improving community health promotion activities and developing program sustainability.