Community action to prevent childhood obesity: lessons from three US case studies

Evaluability assessment of "growing healthy communities," a mini-grant program to improve access to healthy foods and places for physical activity

Background

Mini-grants have been used to stimulate multisector collaboration in support of public health initiatives by funding non-traditional partners, such as economic development organizations. Such mini-grants have the potential to increase access to healthy foods and places for physical activity through built environment change, especially in small and rural towns in the United States. Although a promising practice, few mini-grant evaluations have been done. Therefore, our purpose was to conduct an Evaluability Assessment (EA), which is a process that can help promising programs that lack evidence advance toward full-scale evaluation. Specifically, we conducted an Evaluability Assessment of a statewide mini-grant program, called “Growing Healthy Communities” (GHC), to determine if this program was ready for evaluation and identify any changes needed for future implementation and evaluation that could also inform similar programs.

Methods

Telephone interviews with directors of six past mini-grant recipient organizations were conducted to assess implementation and evaluability. The six interviews were split equally among agencies receiving funding for food-oriented projects and physical activity-oriented projects. Within- and cross-case thematic analyses of interview transcripts were conducted.

Results

Organizational capacity was a universal theme, reflecting other key themes (described in detail in the manuscript) that affected program implementation and evaluation, including collaboration, limited time and measurement integration. Conclusions. The EA process provided pilot data that suggest that other state, regional, and national funders should provide centralized assistance for data collection and evaluation from the outset of a mini-grant award program.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7156-8) contains supplementary material, which is available to authorized users.

Process Evaluation and Lessons Learned From Engaging Local Policymakers in the B'More Healthy Communities for Kids Trial

Partnerships linking researchers to the policymaking process can be effective in increasing communication and supporting health policy. However, these policy partnerships rarely conduct process evaluation. The Policy Working Group (Policy WG) was the policy-level intervention of the multilevel B'More Healthy Communities for Kids (BHCK) trial. The group sought to align interests of local policymakers, inform local food and nutrition policy, introduce policymakers to a new simulation modeling, and sustain intervention levels of BHCK. We conducted an evaluation on the Policy WG between July 2013 and May 2016. We evaluated process indicators for reach, dose-delivered, and fidelity and developed a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The policy intervention was implemented with high reach and dose-delivered. Fidelity measures improved from moderate to nearly high over time. The number of health-related issues on policymakers' agenda increased from 50% in the first 2 years to 150% of the high standard in Year 3. SWOT analysis integrated a stakeholder feedback survey to consider areas of strength, weakness, opportunity, and threats. Although the fidelity of the modeling was low at 37% of the high standard, stakeholders indicated that the simulation modeling should be a primary purpose for policy intervention. Results demonstrate that process evaluation and SWOT analysis is useful for tracking the progress of policy interventions in multilevel trials and can be used to monitor the progress of building partnerships with policymakers.

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.

The critical role of communications in a multilevel obesity-prevention intervention: Lessons learned for alcohol educators

OBJECTIVE

Multilevel interventions to prevent underage drinking are more effective than individual-level strategies, and messaging campaigns are key to such approaches. Recognizing the benefits of translating best practices across public health domains, this paper details the communications campaign from Shape Up Somerville (SUS), an exemplar for multilevel community-based approaches to address pediatric obesity, highlighting lessons learned for alcohol educators.

METHODS

All elements of SUS, including the communications strategy, were developed collaboratively with local partners. Communication initiatives included community-engaged brand development to unify diverse intervention components; school-based communications to promote new opportunities for healthy eating and physical activity; and media partnerships to promote healthy behaviors community-wide.

RESULTS

The overall SUS intervention was effective in reducing prevalence of overweight/obesity among first- to third-graders in Somerville relative to control communities. Process evaluation showed that communications successfully reached diverse community segments and raised awareness of and receptivity to changes.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Communications campaigns are essential components of multilevel interventions addressing public health challenges including obesity and underage drinking. Such communications should be developed collaboratively with the target audience and stakeholders, designed to engage community members at multiple levels through multiple channels within a systems framework, and sustained through local partnerships.