Evaluation of physical projects and policies from the Active Living by Design partnerships

Examining the creation of synergy in community coalitions for smoke-free environments in Armenia and Georgia

Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n = 83) and semi-structured interviews with leaders and members (n = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16 hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy.

Cultivating an Active Living Plan Through a Social-Ecological Evaluation

Physical activity (PA) social-ecological model (SEM) posits the importance of several levels of influence critical for PA promotion within communities. The purpose of this study was to examine an SEM evaluation informing a county-wide active living plan in McLennan County, Texas in the United States. Mixed-methods evaluation occurred in 4 stages: (1) county policies (n = 15) were evaluated for PA promoting strategies; (2) PA resource assessments (PARAs) were conducted via Google Maps (n = 171); (3) surveys (n = 244) included the International Physical Activity Questionnaire and interpersonal and intrapersonal factors related to PA; and (4) focus groups (n = 5) were conducted with residents (n = 30), discussing barriers and facilitators to being active. Logistic regression determined significant associations between SEM factors and meeting PA recommendations. Policy scans and PARAs identified strengths and areas of improvement (eg, equitable project selection and disparities in resource quality). Residents reporting fewer barriers (OR = 0.89, P =.01), more perceived behavioral control (odds ratio [OR] = 1.38, P = .01), more social co-participation in PA (OR = 1.20, P = .03), and living in zip codes with higher mean PARA score (OR = 1.22, P = .04) were significantly more likely to meet PA recommendations (Nagelkerke R2 = 0.32). Focus groups also discussed safety and disparities in access and quality. This study suggests the utility of the SEM when evaluating and promoting community PA.

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

Systematic review of the barriers and facilitators to cross-sector partnerships in promoting physical activity

AIMS

To review the barriers and facilitators that cross-sector partners face in promoting physical activity.

METHODS

We searched Medline, Embase, PsychINFO, ProQuest Central, SCOPUS and SPORTDiscus to identify published records dating from 1986 to August 2021. We searched for public health interventions drawn from partnerships, where the partners worked across sectors and their shared goal was to promote or increase physical activity through partnership approaches. We used the Critical Appraisal Skills Programme UK (CASP) checklist and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool to guide the critical appraisal of included records, and thematic analysis to summarise and synthesise the findings.

RESULTS

Findings (n = 32 articles) described public health interventions (n = 19) aiming to promote physical activity through cross-sector collaboration and/or partnerships. We identified barriers, facilitators and recommendations in relation to four broad themes: approaching and selecting partners, funding, building capacity and taking joint action.

CONCLUSION

Common challenges that partners face are related to allocating time and resources, and sustaining momentum. Identifying similarities and differences between partners early on and building good relationships, strong momentum and trust can take considerable time. However, these factors may be essential for fruitful collaboration. Boundary spanners in the physical activity system could help translate differences and consolidate common ground between cross-sector partners, accelerating joint leadership and introducing systems thinking.

PROSPERO REGISTRATION NUMBER

CRD42020226207.

Governance of Intersectoral Collaborations for Population Health and to Reduce Health Inequalities in High-Income Countries: A Complexity-Informed Systematic Review

BACKGROUND

A 'Health in All Policies' (HiAP) approach has been widely advocated as a way to involve multiple government sectors in addressing health inequalities, but implementation attempts have not always produced the expected results. Explaining how HiAP-style collaborations have been governed may offer insights into how to improve population health and reduce health inequalities.

METHODS

Theoretically focused systematic review. Synthesis of evidence from evaluative studies into a causal logic model.

RESULTS

Thirty-one publications based on 40 case studies from nine high-income countries were included. Intersectoral collaborations for population health and equity were multi-component and multi-dimensional with collaborative activity spanning policy, strategy, service design and service delivery. Governance of intersectoral collaboration included structural and relational components. Both internal and external legitimacy and credibility delivered collaborative power, which in turn enabled intersectoral collaboration. Internal legitimacy was driven by multiple structural elements and processes. Many of these were instrumental in developing (often-fragile) relational trust. Internal credibility was supported by multi-level collaborations that were adequately resourced and shared power. External legitimacy and credibility was created through meaningful community engagement, leadership that championed collaborations and the identification of 'win-win' strategies. External factors such as economic shocks and short political cycles reduced collaborative power.

CONCLUSION

This novel review, using systems thinking and causal loop representations, offers insights into how collaborations can generate internal and external legitimacy and credibility. This offers promise for future collaborative activity for population health and equity; it presents a clearer picture of what structural and relational components and dynamics collaborative partners can focus on when planning and implementing HiAP initiatives. The limits of the literature base, however, does not make it possible to identify if or how this might deliver improved population health or health equity.

The planning and reporting of mixed methods studies on the built environment and health

Researchers examining the influence of the built environment on health are increasingly using mixed methods approaches. The use of more than one type of methodology to address a single research question is compelling in this field because researchers investigating the impact of the built environment on health have been faced with proposing solutions to a complex societal problem involving interacting systems and social uncertainties. Mixed methods studies can help researchers to gain a better understanding of the relationships that exist between humans and their environment by drawing on qualitative and quantitative methods. Mixed methods studies could also be instrumental for providing effective policy solutions. This is because they allow researchers to identify built environment determinants of health in a population of interest and to understand the social and cultural factors that might influence the uptake of an intervention by this population. The objective of this paper is to assist those conducting research on the built environment and health who may have little background in mixed methods. We provide an overview of mixed methods research designs and provide concrete techniques for the integration of diverse methods. We also discuss the recommendations for mixed methods research in the field of built environment - health research, drawing on specific examples from published studies. Reporting a research design and an integration strategy in mixed methods studies could help to strengthen our ability to gain new insights into the multidimensional nature of the relationship between the built environment and health.

Impact of NFL PLAY 60 Programming on Elementary School Children's Body Mass Index and Aerobic Capacity: The NFL PLAY 60 FitnessGram Partnership Project

BACKGROUND

We examined the impact of the Fuel Up to Play 60 (FUTP60) program on children's body mass index (BMI) and aerobic capacity (AC).

METHODS

Participation in the FUTP60 and both BMI and AC profiles were collected through the NFL PLAY 60 FitnessGram Partnership Project involving over 100 schools from 22 US states. We specifically examined the distributions of BMI and AC among participating versus nonparticipating schools in the 2012-2013 school year. Hierarchical linear models tested the impact of participation and availability of additional funding for program implementation on the proportions of youth meeting FitnessGram health-related fitness standards (ie, Needs Improvement-Health Risk [NIHR] and Healthy Fitness Zone [HFZ] categories).

RESULTS

After 1 year implementing the program, participating schools had lower proportions of boys (-4.1 ± 2.0%, p = .04) and girls (-4.5 ± 2.0%, p = .03) in the NIHR for BMI, and lower proportion of girls (-9.7 ± 4.0%, p = .02) in the NIHR for AC. There were no differences in the distributions for the HFZ and the availability of additional funding did not alter the relationships (p > .05).

CONCLUSIONS

This study provides preliminary evidence that participation in the FUTP60 is associated with improved profiles of health-related fitness.

Using a Community Workshop Model to Initiate Policy, Systems, and Environmental Change That Support Active Living in Indiana, 2014-2015

BACKGROUND

Engaging in regular physical activity reduces the likelihood of developing chronic diseases. A community's rates of physical activity are directly connected to its built environment characteristics, which correspondingly affect the chronic disease prevalence of its population. Community planning and design interventions can increase levels of physical activity and reduce chronic disease rates by identifying and removing environmental and policy barriers that may hinder active living.

COMMUNITY CONTEXT

Community stakeholder groups of various sizes and in various settings in Indiana are beginning to make changes to their policies, systems, and environments to increase levels of physical activity for residents.

METHODS

We conducted day-long active living workshops in cities and towns in Indiana to help organize and support public officials, community-based organizations, and advocates in their efforts to promote policy, system, and environmental (PSE) changes that lead to more active communities.

OUTCOME

We found that following a consistent process of holding a community workshop and then conducting ongoing follow-up activities led to PSE changes within 1 year. Communities that hosted active living workshops created identifiable changes by supporting active living goals through policy adoption, the creation of new advisory committees, and new local funding allocations.

INTERPRETATION

The collaborative approach in the workshop provides a successful model for communities to build capacity to implement PSE strategies that support active living. This method requires various community stakeholders to work closely together, using a shared approach to make changes that would be difficult to achieve if they were working independently.

Secondary GIS built environment data for health research: guidance for data development

Built environment (BE) data in geographic information system (GIS) format are increasingly available from public agencies and private providers. These data can provide objective, low-cost BE data over large regions and are often used in public health research and surveillance. Yet challenges exist in repurposing GIS data for health research. The GIS data do not always capture desired constructs; the data can be of varying quality and completeness; and the data definitions, structures, and spatial representations are often inconsistent across sources. Using the Small Town Walkability study as an illustration, we describe (a) the range of BE characteristics measurable in a GIS that may be associated with active living, (b) the availability of these data across nine U.S. small towns, (c) inconsistencies in the GIS BE data that were available, and (d) strategies for developing accurate, complete, and consistent GIS BE data appropriate for research. Based on a conceptual framework and existing literature, objectively measurable characteristics of the BE potentially related to active living were classified under nine domains: generalized land uses, morphology, density, destinations, transportation system, traffic conditions, neighborhood behavioral conditions, economic environment, and regional location. At least some secondary GIS data were available across all nine towns for seven of the nine BE domains. Data representing high-resolution or behavioral aspects of the BE were often not available. Available GIS BE data - especially tax parcel data - often contained varying attributes and levels of detail across sources. When GIS BE data were available from multiple sources, the accuracy, completeness, and consistency of the data could be reasonable ensured for use in research. But this required careful attention to the definition and spatial representation of the BE characteristic of interest. Manipulation of the secondary source data was often required, which was facilitated through protocols.

How to Identify Success Among Networks That Promote Active Living

OBJECTIVES

We evaluated organization- and network-level factors that influence organizations' perceived success. This is important for managing interorganizational networks, which can mobilize communities to address complex health issues such as physical activity, and for achieving change.

METHODS

In 2011, we used structured interview and network survey data from 22 states in the United States to estimate multilevel random-intercept models to understand organization- and network-level factors that explain perceived network success.

RESULTS

A total of 53 of 59 "whole networks" met the criteria for inclusion in the analysis (89.8%). Coordinators identified 559 organizations, with 3 to 12 organizations from each network taking the online survey (response rate = 69.7%; range = 33%-100%). Occupying a leadership position (P < .01), the amount of time with the network (P < .05), and support from community leaders (P < .05) emerged as correlates of perceived success.

CONCLUSIONS

Organizations' perceptions of success can influence decisions about continuing involvement and investment in networks designed to promote environment and policy change for active living. Understanding these factors can help leaders manage complex networks that involve diverse memberships, varied interests, and competing community-level priorities.

A community-based intervention increases physical activity and reduces obesity in school-age children in North Carolina

BACKGROUND

Community-based interventions are promising approaches to obesity prevention, but few studies have prospectively evaluated them. The aim of this study was to evaluate a natural experiment—a community intervention designed to promote active living and decrease obesity within a small southern town.

METHODS

In 2011, community leaders implemented the Mebane on the Move intervention—a community-wide effort to promote physical activity (PA) and decrease obesity among residents of Mebane, North Carolina. We measured child PA and BMI before and after the intervention, using a nearby town not implementing an intervention as the comparison. In total, we assessed 64 children from Mebane and 40 from the comparison community 6 months before, as well as 34 and 18 children 6 months after the intervention. We assessed PA with accelerometers worn for 7 days and calculated BMI z-scores using children's height and weight. We conducted multivariable linear regressions examining pre- to postintervention change in minutes of PA and BMI z-score, adjusting for confounders.

RESULTS

At follow-up, children in Mebane modestly increased their moderate-to-vigorous PA (1.3 minutes per hour; 95% confidence interval (CI): 0.2, 2.3; p=0.03) and vigorous activity (0.8 minutes per hour; 95% CI: 0.1, 1.5; p=0.04) more than comparison children. In intervention children, BMI z-scores decreased 0.5 units (kg/m(2); 95% CI: -0.9, -0.02; p=0.045), compared to children in the comparison community.

CONCLUSIONS

We observed positive effects on PA level and weight status of children in Mebane, despite high rates of attrition, suggesting that the community-based intervention may have been successful.

Relating built environment to physical activity: two failures to validate

The Irvine-Minnesota Inventory (IMI) is an audit tool used to record properties of built environments. It was designed to explore the relationships between environmental features and physical activity. As published, the IMI does not provide scoring to support this use. Two papers have since been published recommending methods to form scales from IMI items. This study examined these scoring procedures in new settings. IMI data were collected in two urban settings in Alberta in 2008. Scale scores were calculated using the methods presented in previous papers and used to test whether the relationships between IMI scales and walking behaviors were consistent with previously reported results. The scales from previous work did not show expected relationships with walking behavior. The scale construction techniques from previous work were repeated but scales formed in this way showed little similarity to previous scales. The IMI has great potential to contribute to understanding relationships between built environment and physical activity. However, constructing reliable and valid scales from IMI items will require further research.

Lessons in promoting active living: the collaborative perspective

CONTEXT

Collaborative groups are integral in health promotion and disease prevention and use an ecological approach to address complex health conditions in community settings. Little is known about collaborative efforts to promote active living.

OBJECTIVE

The objective of this analysis is to explore successes and challenges of collaborative groups in promoting active living in their communities.

DESIGN/SETTING

One-time, structured telephone interviews were conducted to assess the composition tactics and activities and approaches used by collaboratives to promote active living.

PARTICIPANTS

Collaborative groups were referred by Physical Activity Policy Research Network members or found through online searches. Interviews were conducted with coordinators of 59 collaborative groups.

MAIN OUTCOME MEASURE(S)

Analysis focused on successes and challenges of collaborative groups' policies, programs, and/or projects as described by collaborative group coordinators. We used the Grounded Theory method approach to code and abstract themes from 2 open-ended response sets.

RESULTS

Collaboratives' most successful projects centered on strategies using environmental (41%) or policy (31%) approaches to promote active living. While 80% of groups reported that their most successful project was funded, funding was also identified as a primary challenge for 71% of the collaboratives. Personnel issues were a common challenge for 54%. Opposition to successful projects ranged from community issues to collaborative member issues, although more than half the groups experienced no opposition.

CONCLUSIONS

Groups that aligned goals, strategies, and funding to advance changes to the built environment were likely to identify their projects as successful. Perceptions of opposition and attitudes toward success may be important precursors to project outcomes of active living collaboratives and warrant further investigation. Lessons from these active living collaborative groups can provide guidance for other groups planning for environmental and policy change.

Active living by design sustainability strategies

BACKGROUND

Despite substantial increases in improving the translation of health promotion research into practice, community initiatives still struggle with maintaining changes once grant funding has ended. Researchers, funders, and community practitioners are interested in practices that maintain and sustain their efforts.

PURPOSE

This qualitative study conducted a content analysis of evaluation findings from Active Living by Design (ALbD) to identify activities that community coalitions implemented to maintain their initiative and secure ongoing influence in communities.

METHODS

Investigators analyzed data from interviews, focus groups, and the Progress Reporting System to identify sustainability approaches clustering into five areas: partnership expansion, sustainable funding, permanent advisory committees, policy change, and institution/organization change.

RESULTS

Partnership expansion occurred across sectors and disciplines and into broader geographic areas. Additional funding extended beyond grants to earned income streams and dedicated tax revenues. Permanent advisory committees were established to inform decision makers about a range of active living impacts. Policy changes in zoning and comprehensive plans ensured maintenance of health-promoting built environments. Sustainability through institution/organization changes led to allocation of dedicated staff and incorporation of active living values into agency missions.

CONCLUSIONS

Active Living by Design partnerships defined and messaged their projects to align with policymakers' interests and broad partnership audiences. They found innovative supporters and adapted their original vision to include quality of life, nonmotorized transport, and other complementary efforts that expanded their reach and influence. These sustainability strategies altered awareness within communities, changed community decision-making processes, and created policy changes that have the potential to maintain environments that promote physical activity for years to come.

Evaluation of Active Living by Design: implementation patterns across communities

BACKGROUND

Twenty-five cross-sector, multidisciplinary community partnerships received funding through the Active Living by Design (ALbD) national program to design, plan, and implement innovative initiatives to support active living.

PURPOSE

This paper examines implementation patterns across ALbD community partnerships related to community characteristics; preparation efforts; and policy, environmental, programmatic, and promotional strategies.

METHODS

Investigators used a mixed-methods, participatory evaluation design, triangulating multiple qualitative and quantitative data sources collected from 2007 to 2009. Configural frequency analysis facilitated detection of variables as well as configurations of variables occurring more (types) or less (anti-types) frequently than patterns expected by chance alone.

RESULTS

Overall, community partnerships with more preparation activities (assessment, sustainability) implemented a larger number of active living promotions, programs, policy influences, and physical projects, cumulatively (type). Yet, community partnerships working in communities with >40% of the population from a non-Caucasian racial and ethnic background and >40% of the population in poverty implemented fewer active living promotions, programs, policy influences, and physical projects, cumulatively (type).

CONCLUSIONS

The resulting types and anti-types provide insight into patterns across communities that may be ascribed to varying configurations of community contexts, resources, and strategies implemented. Rigorous, systematic examination of the underlying causal structures related to the configurations of community characteristics, preparation efforts, and implementation strategies is needed.

Capturing community change: Active Living by Design's progress reporting system

The Active Living by Design (ALbD) National Program Office (NPO) developed an evaluation system to track progress of 25 community partnerships, funded by the Robert Wood Johnson Foundation (RWJF). Between June 2004 and October 2008, partnerships documented their actions and accomplishments through ALbD's online Progress Reporting System (PRS) database. All entries were verified and analyzed by the NPO. Results from the PRS suggest that the ALbD partnerships were successful fundraisers, leveraging $256 million from grants, policy decisions, in-kind and direct sources. The partnerships also documented newspaper coverage, TV, and radio air time and they developed physical activity programs such as exercise clubs and "walking school buses." Partnerships were adept at influencing decision makers to create or rewrite policies and improve built environments. Selected policy examples included, but were not limited to, approvals for capital improvements, street design standards, and development ordinances. Partnerships also contributed to the completion and approval of influential planning products, such as comprehensive land use, neighborhood, and roadway corridor plans. The most common built-environment changes were street improvements for safer pedestrian and bicycle travel, including new crosswalks, bicycle facilities, and sidewalks. The ALbD community partnerships' accomplishments and challenges contribute to knowledge and best practices in the active living field. Five years after their grant began, RWJF's initial investment showed substantial and measurable results.