Using frameworks to diagram value in complex policy and environmental interventions to prevent childhood obesity.

BACKGROUND: To date, few tools assist policy makers and practitioners in understanding and conveying the implementation costs, potential impacts, and value of policy and environmental changes to address healthy eating, active living, and childhood obesity. For the Evaluation of Healthy Kids, Healthy Communities (HKHC), evaluators considered inputs (resources and investments) that generate costs and savings as well as benefits and harms related to social, economic, environmental, and health-related outcomes in their assessment of 49 HKHC community partnerships funded from 2009 to 2014. METHODS: Using data collected through individual and group interviews and an online performance monitoring system, evaluators created a socioecological framework to assess investments, resources, costs, savings, benefits, and harms at the individual, organizational, community, and societal levels. Evaluators customized frameworks for 6 focal strategies: active transportation, parks and play spaces, child care physical activity standards, corner stores, farmers' markets, and child care nutrition standards. RESULTS: To illustrate the Value Frameworks, this brief highlights the 38 HKHC communities implementing at least 1 active transportation strategy. Evaluators populated this conceptual Value Framework with themes from the strategy-specific inputs and outputs. The range of factors corresponding to the implementation and impact of the HKHC community partnerships are highlighted along with the inputs and outputs. CONCLUSIONS: The Value Frameworks helped evaluators identify gaps in current analysis models (ie, benefit-cost analysis, cost-effectiveness analysis) as well as paint a more complete picture of value for potential obesity prevention strategies. These frameworks provide a comprehensive understanding of investments needed, proposed costs and savings, and potential benefits and harms associated with economic, social, environmental, and health outcomes. This framing also allowed evaluators to demonstrate the interdependence of each socioecological level on the others in these multicomponent interventions. This model can be used by practitioners and community leaders to assess realistic and sustainable strategies to combat childhood obesity.

Applying a mixed-methods evaluation to Healthy Kids, Healthy Communities.

From 2008 to 2014, the Healthy Kids, Healthy Communities (HKHC) national program funded 49 communities across the United States and Puerto Rico to implement healthy eating and active living policy, system, and environmental changes to support healthier communities for children and families, with special emphasis on reaching children at highest risk for obesity on the basis of race, ethnicity, income, or geographic location. Evaluators designed a mixed-methods evaluation to capture the complexity of the HKHC projects, understand implementation, and document perceived and actual impacts of these efforts. Eight complementary evaluation methods addressed 4 primary aims seeking to (1) coordinate data collection for the evaluation through the web-based project management system (HKHC Community Dashboard) and provide training and technical assistance for use of this system; (2) guide data collection and analysis through use of the Assessment and Evaluation Toolkit; (3) conduct a quantitative cross-site impact evaluation among a subset of community partnership sites; and (4) conduct a qualitative cross-site process and impact evaluation among all 49 community partnership sites. Evaluators identified successes and challenges in relation to the following methods: an online performance-monitoring HKHC Community Dashboard system, environmental audits, direct observations, individual and group interviews, partnership and community capacity surveys, group model building, photographs and videos, and secondary data sources (surveillance data and record review). Several themes emerged, including the value of systems approaches, the need for capacity building for evaluation, the value of focusing on upstream and downstream outcomes, and the importance of practical approaches for dissemination. The mixed-methods evaluation of HKHC advances evaluation science related to community-based efforts for addressing childhood obesity in complex community settings. The findings are likely to provide practice-relevant evidence for public health.

Partnership and community capacity characteristics in 49 sites implementing healthy eating and active living interventions.

BACKGROUND: One component of the Evaluation of Healthy Kids, Healthy Communities, funded by the Robert Wood Johnson Foundation, was to assess partnership and community capacity characteristics of 49 cross-sector, multidisciplinary community demonstration projects to increase healthy eating and active living as well as to prevent and reduce childhood obesity. METHODS: From December 2012 to December 2013, an 82-item partnership and community capacity survey instrument assessed perspectives of community partnership members and community representatives from 48 of the 49 communities on the structure and function of their partnerships and the capacity of the community to create change. Through factor analysis and descriptive statistics, the evaluators described common characteristics of the partnerships, their leadership, and their relationships to the broader communities. RESULTS: A total of 603 individuals responded from 48 of the 49 partnerships. Evaluators identified 15 components, or factors that were broken into a themes, including leadership, partnership structure, relationship with partners, partnership capacity, political influence of partnership, and perceptions of partnership's involvement with the community and community members. CONCLUSIONS: Survey respondents perceived the Healthy Kids, Healthy Communities partnerships to have the capacity to ensure the partnerships' effectiveness in forming and growing their structures and functions, collaborating to implement policy and environmental change, and planning for sustainability.

Collaborating to support Healthy Kids, Healthy Communities partnerships.

The Robert Wood Johnson Foundation (RWJF) (http://www.rwjf.org/en.html) launched Healthy Kids, Healthy Communities (HKHC) in 2008, with a $33.4 million commitment to help reverse the childhood obesity epidemic by 2015. With grant funding and technical assistance, HKHC supported 50 diverse community partnerships focusing on populations at greatest risk for obesity. Active Living By Design served as the national program office, and St. Louis-based Transtria conducted the evaluation. Collaboration fundamentally shaped HKHC's national program design and strategy, the grantee selection process, technical assistance, the HKHC learning network, and evaluation. This article describes the ways in which the concept of collaboration was defined and practiced among the Robert Wood Johnson Foundation, Active Living By Design, Transtria, and other national partners, and how it shaped the evolving vision for and expectations from HKHC grantees. Collaboration contributed to HKHC grantees' success, helped build the healthy communities movement, and influenced philanthropic practices.

Assessment for active living: harnessing the power of data-driven planning and action.

BACKGROUND: Robert Wood Johnson Foundation's Active Living by Design (ALbD) grant program funded 25 communities across the U.S. The ALbD National Program Office (NPO) supported grantee community partnerships with technical assistance for assessment, planning, and implementation activities intended to increase population levels of physical activity. PURPOSE: This paper analyzes and summarizes the range of assessments conducted to identify local barriers and opportunities for active living as important elements of a thorough intervention planning process. METHODS: Evaluation of the partnerships focused on documenting community changes and strategies used to produce those changes. With support from NPO staff and external evaluators, partnerships tracked and summarized their community assessment approaches as well as strengths and challenges in conducting assessments. RESULTS: The partnerships documented a range of assessment strategies and methods. Partnerships used several qualitative methods, including focus groups, individual and group interviews, and public meetings. Quantitative methods included surveys, audits, observations, and analysis of existing data, among others. The environmental audit was the most common assessment method used by the partnerships. Assessment processes and findings were used for not only intervention planning but also community engagement and direct advocacy. Assessment data collectors varied from professional staff to community volunteers. CONCLUSIONS: Assessments were essential to the identification of local barriers and assets related to active living, which in turn helped ALbD partnerships prioritize and refine their action strategies. Assessment processes were also valuable in building relationships with new partners, community members, and local officials.

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.

Linking perceptions of the community to behavior: are protective social factors associated with physical activity?

Although the relationship of psychosocial factors to physical activity has been explored, there is increased interest in how perceptions of the community environment influence behavior. However, few methodological studies have incorporated perceptions of the social and community environment (protective social factors) or addressed key measurement issues. Computer-assisted telephone interviews were administered to a national sample of 1,818 U.S. adults. Unadjusted and multivariate-adjusted odds ratios were calculated to compare active and inactive participants by Protective Social Factors (PSF) scores and selected sociodemographics. Confirmatory factor analysis and reliability analysis suggested strong PSF scale psychometric properties (alpha = .92). After adjustment for potential confounders, a 10-point rise in the PSF score resulted in a 12% increased likelihood of meeting Centers for Disease Control and Prevention/American College of Sports Medicine recommendations. Additional analyses indicated that greater perceived PSFs were associated with meeting these recommendations among Whites but not among African Americans.