Participatory Monitoring and Evaluation of the COVID-19 Response in a Local Public Health System.

The coronavirus disease 2019 (COVID-19) pandemic tested the capacity of local health systems to understand and respond to changing conditions. Although data on new cases of COVID-19 were widely shared in communities, there was less information on the multisector response activities and factors associated with implementation. To address this gap, this empirical case study examined (a) the pattern of implementation of COVID-19 response activities and (b) the factors and critical events associated with both the pattern of new cases and the implementation of the local COVID-19 response. We used a participatory monitoring and evaluation system to capture, code, characterize, and communicate 580 COVID-19 response activities implemented in the city of Lawrence and Douglas County, Kansas. Collaboration across sectors including public health, medical services, city/county government, businesses, social services, public schools, and universities enabled the local public health system's response effort. Documentation results showed the varying pattern of new COVID-19 cases and response activities over time and the factors identified as enabling or impeding the response and related new cases. Similar participatory monitoring and evaluation methods can be used by local health systems to help understand and respond to the changing conditions of COVID-19 response and recovery.

Association of Multisetting Community Programs and Policies With Child Body Mass Index: The Healthy Communities Study.

INTRODUCTION: Expert opinion suggests that efforts to address childhood obesity should seek to transform the environments in which children operate. The objective of this study was to describe the extent to which multisetting programs and policies interact with community and child predictors and are associated with child body mass index (BMI) in the 130 US communities participating in the Healthy Communities Study. METHODS: For 2 years beginning in fall 2013, we collected data through key informant interviews on community programs and policies related to healthy weight among children that occurred in the 10 years before the interview. We characterized community programs and policies by intensity of efforts and the number of settings in which a program or policy was implemented. Child height and weight were measured during household data collection. We used multilevel modeling to examine associations of community programs and policies in multiple settings and child and community predictors with BMI z scores of children. RESULTS: The mean number of settings in which community policies and programs were implemented was 7.3 per community. Of 130 communities, 31 (23.8%) implemented community programs and policies in multiple settings. Higher-intensity community programs and policies were associated with lower BMI in communities that used multiple settings but not in communities that implemented programs and policies in few settings. CONCLUSION: Efforts to prevent childhood obesity may be more effective when community programs and policies are both intensive and are implemented in multiple settings in which children live, learn, and play.

Evaluating implementation of the Ebola response in Margibi County, Liberia.

Implementation of the Ebola response was credited with reducing incidence of Ebola virus disease (EVD) in West Africa; however little is known about the amount and kind of Ebola response activities that were ultimately successful in addressing the 2014 outbreak. We collaboratively monitored Ebola response activities and associated effects in Margibi County, Liberia, a rural county in Liberia deeply affected by the outbreak. We used a participatory monitoring and evaluation system, including key informant interviews and document review, to systematically document activities, code them, characterize their contextual features, and discover and communicate patterns in Ebola response activities to essential stakeholders. We also measured incidence of EVD over time. Results showed a distinct pattern in Ebola response activities and key events, which corresponded with subsequent decreased EVD incidence. These data are suggestive of the role of Ebola response activities played in reducing the incidence of EVD within Margibi County, which included implementing safe burials, social mobilization and community engagement and case management. Systematic monitoring and evaluation of response activities to control disease outbreaks holds lessons for implementing and evaluating similar comprehensive and multi-sectoral community health efforts.

Monitoring and Evaluating the Ebola Response Effort in Two Liberian Communities.

Although credited with ultimately reducing incidence of Ebola Virus Disease (EVD) in West Africa, little is known about the amount and kind of Ebola response activities associated with reducing the incidence of EVD. Our team monitored Ebola response activities and associated effects in two rural counties in Liberia highly affected by Ebola. We used a participatory monitoring and evaluation system, and drew upon key informant interviews and document review, to systematically capture, code, characterize, and communicate patterns in Ebola response activities. We reviewed situation reports to obtain data on incidence of EVD over time. Results showed enhanced implementation of Ebola response activities corresponded with decreased incidence of EVD. The pattern of staggered implementation of activities and associated effects-replicated in both counties-is suggestive of the role of Ebola response activities in reducing EVD. Systematic monitoring of response activities to control disease outbreaks holds lessons for implementing and evaluating multi-sector, comprehensive community health efforts.

Carbon pollution increases health inequities: lessons in resilience from the most vulnerable.

Climate change is a social justice as well as an environmental issue. The magnitude and pattern of changes in weather and climate variables are creating differential exposures, vulnerabilities, and health risks that increase stress on health systems while exacerbating existing and creating new health inequities. Examples from national and local health adaptation projects highlight that developing partnerships across sectors and levels are critical for building climate-resilient health systems and communities. Strengthening current and implementing new health interventions, such as using environmental information to develop early warning systems, can be effective in protecting the most vulnerable. However, not all projected risks of climate change can be avoided by climate policies and programs, so health system strengthening is also critical. Applying a health inequity lens can reduce current vulnerabilities while building resilience to longer-term climate change. Taking inequities into account is critical if societies are to effectively prepare for and manage the challenges ahead.

Participatory evaluation of a community mobilization effort to enroll Wyandotte County, Kansas, residents through the Affordable Care Act.

Successful implementation of the Affordable Care Act (ACA) depends on the capacity of local communities to mobilize for action. Yet the literature offers few systematic investigations of what communities are doing to ensure support for enrollment. In this empirical case study, we report implementation and outcomes of Enroll Wyandotte, a community mobilization effort to facilitate enrollment through the ACA in Wyandotte County, Kansas. We describe mobilization activities during the first round of open enrollment in coverage under the ACA (October 1, 2013-March 31, 2014), including the unfolding of community and organizational changes (e.g., new enrollment sites) and services provided to assist enrollment over time. The findings show an association between implementation measures and newly created accounts under the ACA (the primary outcome).

Measuring progress of collaborative action in a community health effort.

OBJECTIVE: To measure the progress made by the collaborative actions of multisectorial partners in a community health effort using a systematic method to document and evaluate community/system changes over time. METHODS: This was a community-based participatory research project engaging community partners of the Latino Health for All Coalition, which based on the Health for All model, addresses health inequity in a low-income neighborhood in Kansas City, Kansas, United States of America. Guided by three research questions regarding the extent to which the Coalition catalyzed change, intensity of change, and how to visually display change, data were collected on community/system changes implemented by the community partners from 2009-2012. These changes were characterized and rated according to intensity (event duration, population reach, and strategy) and by other categories, such as social determinant of health mechanism and sector. RESULTS: During the 4-year study period, the Coalition implemented 64 community/system changes. These changes were aligned with the Coalition's primary goals of healthy nutrition, physical activity, and access to health screenings. Community/system efforts improved over time, becoming longer in duration and reaching more of the population. CONCLUSIONS: Although evidence of its predictive validity awaits further research, this method for documenting and characterizing community/system changes enables community partners to see progress made by their health initiatives.

Synergy for health equity: integrating health promotion and social determinants of health approaches in and beyond the Americas.

Health promotion and social determinants of health approaches, when integrated, can better contribute to understanding and addressing health inequities. Yet, they have typically been pursued as two solitudes. This paper presents the key elements, principles, actions, and potential synergies of these complementary frameworks for addressing health equity. The value-added of integrating these two approaches is illustrated by three examples drawn from the authors' experiences in the Americas: at the community level, through a community-based coalition for reducing chronic disease disparities among minorities in an urban center in the United States; at the national level, through healthy-settings interventions in Canada; and at the Regional level, through health cooperation based on social justice values in Latin America. Challenges to integrating health promotion and social determinants of health approaches in the Americas are also discussed.

The Enough Abuse Campaign: building the movement to prevent child sexual abuse in Massachusetts.

This case study describes the Enough Abuse Campaign, a multidisciplinary, statewide effort to prevent child sexual abuse in Massachusetts. The study uses the Institute of Medicine's Framework for Collaborative Community Action on Health to provide a systematic description of the campaign's process of implementation, which includes: (a) developing a state-level infrastructure for child sexual abuse prevention, (b) assessing child sexual abuse perceptions and public opinion, (c) developing local infrastructures in three communities and implementing training programs focused on preventing perpetration of child sexual abuse, (d) facilitating changes in local communities to child-sexual-abuse-related systems, and (e) inviting Massachusetts residents to join an advocacy-based movement to prevent child sexual abuse. This case study concludes with future directions for the campaign and topics for future research related to child sexual abuse.

Behavioral Interventions Contributing to Reducing Poverty and Inequities.

Behavioral science has a long history of engaging in efforts to understand and address socially important issues. Poverty and inequities in health and development are among the most important and complex social issues facing the world today. With its Sustainable Development Goals (SDGs), the United Nations (2015) has focused attention and guidance on addressing key global challenges, including to "end poverty" (SDG 1), "ensure good health and well-being for all" (SDG3), and "reduce inequality within and among countries" (SDG 10). In this paper, we provide a framework and illustrative examples of contributions of behavioral science to these issues. We feature illustrative behavioral interventions at the individual, relationship, community, and societal levels. We highlight the diversity of issues, intervention methods, and settings reflected in applications of behavioral science. By joining methods from behavioral science, public health, and other disciplines-and the experiential knowledge of those most affected by inequities-behavioral methods can make significant contributions to collaborative efforts to assure health and well-being for all.

A Reflection on Community Research and Action as an Evolving Practice.

Community research and action is an evolving field of practice with multiple influences. Its varied ways of knowing and doing reflect recombined elements from different disciplines, including behavioral science, community psychology, public health, and community development. This article offers a personal reflection based on my evolving practice over nearly 50 years. The focus is on three types of influence: (a) engaging with different communities, fields, and networks (e.g., discovering shared values, diverse methods); (b) building methods and capabilities for the work (e.g., methods for participatory research, tools for capacity building); and (c) partnering for collaborative research and action, locally and globally. This story highlights the nature of the field's evolution as an increasing variation in methods. Our evolving practice of community research and action-individually and collectively-emerges from the recombination of ideas and methods discovered through engagement in a wide variety of contexts.

A case study of use of data for participatory evaluation within a statewide system to prevent substance abuse.

Although evaluation is considered an essential component of community health initiatives, its function requires actual use of the data to inform practice. The purpose of this case study was to examine how often and in what ways practitioners in a state system for substance abuse prevention used participatory evaluation data. To assess uses of data, interviews and surveys (N = 13) were conducted with practitioners. Questions focused on the frequency of use for several functions of evaluation data. Results showed that 77% of participants reported using their data within the past 30 days to review progress of the initiative, and 64% had used the data to communicate successes or needed improvement to staff. Fewer participants indicated they had used the data to communicate accomplishments to stakeholders (54%) or to make adjustments to plans (38%). This study suggests that participatory evaluation data can have multiple functions and uses for community health practitioners.

Evaluating mobilization strategies with neighborhood and faith organizations to reduce risk for health disparities.

Health disparities, differences in health status, and mortality among different groups have challenged the public health commitment to health for all. African Americans and Latinos have historically experienced greater prevalence and mortality from many chronic diseases than Whites. Community mobilization is a promising approach to addressing health disparities. The Kansas City-Chronic Disease Coalition (KC-CDC), a REACH 2010 initiative, aimed to engage neighborhoods and faith organization in changing conditions to reduce risk for cardiovascular disease and diabetes. Using a time series design replicated with each of these two sectors, we examined the effects of a microgrant strategy and a resource distribution strategy on the coalition's facilitation of community change. Results indicate that both strategies increased the implementation of community change by neighborhood and faith organizations, with higher rates of change for the microgrant strategy. This study holds important implications for public health practitioners working with neighborhood and faith-based organizations to address health disparities.

A framework for community mobilization to promote healthy youth development.

In community mobilization to prevent youth violence, local people take action to create conditions under which youth are healthy and safe. This manuscript outlines a framework for supporting and evaluating community mobilization to promote healthy youth development as an approach to preventing youth violence. The framework highlights 12 key community processes to facilitate change and improvement. A descriptive case study of the Ivanhoe Neighborhood Council Youth Project (INCYP) is used to illustrate the application of this framework in an inner-city, predominantly African-American neighborhood in Kansas City, Missouri. Data are presented on community change (i.e., new or modified programs, policies, and practices) facilitated by the INCYP between 2001 and 2003, as an intermediate measure used to assess the mobilization effort. The INCYP facilitated 26 community changes during the project period, and was an effective catalyst for mobilizing the community to support change in outcomes and conditions that support healthy youth development. This case study suggests the importance of early and ongoing engagement of youth as change agents in the community mobilization effort.

Analyzing a community-based coalition's efforts to reduce health disparities and the risk for chronic disease in Kansas City, Missouri.

BACKGROUND: Although it is well known that racial and ethnic minorities in the United States have a higher prevalence of chronic diseases and a higher rate of related deaths than the overall U.S. population, less is understood about how to create conditions that will reduce these disparities. CONTEXT: We examined the effectiveness of a collaborative community initiative--the Kansas City-Chronic Disease Coalition--as a catalyst for community changes designed to reduce the risk for cardiovascular diseases and diabetes among African Americans and Hispanics in Kansas City, Missouri. METHODS: Using an empirical case study design, we documented and analyzed community changes (i.e., new or modified programs, policies, or practices) facilitated by the coalition, information that may be useful later in determining the extent to which these changes may contribute to a reduced risk for adverse health outcomes among members of the target population. We also used interviews with key partners to identify factors that may be critical to the coalition's success. RESULTS: We found that the coalition facilitated 321 community changes from October 2001 through December 2004. Of these changes, 75% were designed to reduce residents' risk for both cardiovascular disease and diabetes, 56% targeted primarily African Americans, and 56% were ongoing. The most common of several strategies was to provide health-related information to or enhance the health-related skills of residents (38%). CONCLUSION: Results suggest that the coalition's actions were responsible for numerous community changes and that certain factors such as hiring community mobilizers and providing financial support to nontraditional partners may have accelerated the rate at which these changes were made. In addition, our analysis of the distribution of changes by various parameters (e.g., by goal, target population, and duration) may be useful in predicting future population-level health improvement.

Community Policies and Programs to Prevent Obesity and Child Adiposity.

INTRODUCTION: Evidence regarding impact of community policies and programs (CPPs) to prevent child obesity is limited, and which combinations of strategies and components are most important is not understood. The Healthy Communities Study was an observational study to assess relationships of characteristics and intensity of CPPs with adiposity, diet, and physical activity in children, taking advantage of variation across the U.S. in community actions to prevent child obesity. The study examined the association of CPPs to prevent child obesity with measured BMI and waist circumference, hypothesizing that communities with more-comprehensive CPPs would have children with lower adiposity. METHODS: The study included 130 communities selected by probability-based sampling or because of known CPPs targeting child obesity. Data were collected at home visits on 5,138 children during 2013-2015. CPPs were scored for multiple attributes to create a CPP intensity score. A CPP target behavior score reflected the number of distinct target behaviors addressed. Scores were standardized with the smallest observed score across communities being 0 and the largest 1. Multilevel regression analysis in 2016 adjusted for community, household, and individual characteristics. RESULTS: Higher CPP target behavior score was significantly associated with lower BMI and waist circumference in a dose-response relationship, with magnitude for the past 3 years of CPPs of 0.843 (p=0.013) for BMI and 1.783 cm (p=0.020) for waist circumference. CONCLUSIONS: This study provides plausible evidence that comprehensive CPPs targeting a greater number of distinct physical activity and nutrition behaviors were associated with lower child adiposity.

Using Action Planning to Build Organizational Capacity for the Prevention of Intimate Partner Violence.

The DELTA PREP Project aims to reduce risk for intimate partner violence (IPV). It engaged leadership and staff from 19 statewide domestic violence coalitions in building capacity to prevent IPV before it occurs (rather than solely responding to IPV). This article describes the process and outcomes associated with action planning to create coalition organizational change related to preventing IPV. Coalition staff and leadership planned for organizational changes in six goal areas: leadership, structures and processes, staffing, resource development, partnership development, and member agency development. Action planning was conducted during 2-day, in-person sessions that involved (a) review and refinement of coalition vision and mission statements, (b) interpretation of coalition assessments (for prevention capacity), (c) identification of specific organizational changes to be sought, and (d) specification of action steps for each proposed organizational change to be sought. The results show overall increases in the amounts, and variations in the kinds, of organizational changes that were facilitated by coalitions. Challenges related to action planning and future directions for capacity building among statewide IPV prevention coalitions are discussed.

Developing an Academic-Community Partnership to Promote Soccer-Based Physical Activity Among Latino Youth.

BACKGROUND: The Latino Health for All (LHFA) Coalition used a community-based participatory approach to develop an action plan for addressing chronic disease among Latinos in Kansas City. OBJECTIVES: This study examines the development and implementation of community-based soccer sessions for youth (ages 6-15) by an academic partner from the coalition and a community partner from a nonprofit youth soccer organization. METHODS: The academic and community partners spoke four times over 3 months to plan for these soccer sessions. These conversations ranged from sharing goals to planning logistics. The coalition helped to promote these opportunities through a variety of channels. RESULTS: Eight weekly soccer sessions were implemented, attracting Latino youth who were overweight or obese. These soccer sessions were perceived as enjoyable by youth and were appreciated by their parents. CONCLUSIONS: Successful health promotion efforts require strong relationships between academic and community partners that involve shared goals and complementary skills/ expertise.

Measuring Community Programs and Policies in the Healthy Communities Study.

Childhood obesity is a challenging public health issue facing communities throughout the U.S. Local efforts are believed to be essential to assuring environments that support physical activity and healthy food/beverage consumption among children and their families. However, little is known about how broadly and intensively communities are implementing combinations of programs and policies that address childhood nutrition, physical activity, and weight control. The Healthy Communities Study is a nationwide scientific study in diverse communities to identify characteristics of communities and programs that may be associated with childhood obesity. Data collection occurred in 2013-2015; data analysis will be completed in 2016. As part of the Healthy Communities Study, researchers designed a measurement system to assess the number and scope of community programs and policies and to examine possible associations between calculated "intensity" scores for these programs and policies and behavioral and outcome measures related to healthy weight among children. This report describes the protocol used to capture and code instances of community programs and policies, to characterize attributes of community programs and policies related to study hypotheses, and to calculate the intensity of combinations of community programs and policies (i.e., using the attributes of change strategy, duration, and reach).