Use of Decision Cases for Building SNAP-Ed Implementers' Capacities to Realize Policy, Systems, and Environmental Strategies.

Objective: To develop and validate decision cases as a capacity-building training tool for implementing policy, systems, and environmental (PSE) change strategies.

Design: Study phases were: (1) in-depth interviews conducted repeatedly over a year with Supplemental Nutrition Assistance Program Education (SNAP-Ed) partner sites and once with SNAP-Ed implementers to identify dilemmas when implementing PSE change strategies; (2) decision cases developed to highlight dilemmas; and (3) focus groups with SNAP-Ed implementers to determine decision case utility as a capacity-building training tool.

Setting: A southeastern state.

Participants: SNAP-Ed partner sites and implementers; Focus group participants.

Intervention: Decision cases.

Analysis: To establish content validity, a thematic analysis of interviews identified common dilemmas when implementing PSE change strategies. SNAP-Ed implementers' focus groups provided feedback to determine the utility and validity of decision cases developed from the analysis.

Results: Common dilemmas of implementation of PSE change strategies reported by SNAP-Ed partner sites (n = 20) and implementers (n = 8) were lack of site and educator readiness and capacity; communication breakdowns; and prioritization of nutrition education over PSE implementation. Focus group participants (n = 8) reviewed a case and discussion guide and recommended them as a capacity-building tool for training.

Conclusions And Implications: Using decision cases could help build SNAP-Ed implementers' capacities to implement nutrition PSE change strategies and strengthen partnerships.