A growing number of health systems are leading health promotion efforts in their wider communities. What impact are these efforts having on health behaviors and ultimately health status? This paper ...presents evaluation results from the place-based Kaiser Permanente Healthy Eating Active Living Zones obesity prevention initiative, implemented in 2011–2015 in 12 low-income communities in Kaiser Permanente’s Northern and Southern California Regions.
The Healthy Eating Active Living Zones design targeted places and people through policy, environmental, and programmatic strategies. Each Healthy Eating Active Living Zone is a small, low-income community of 10,000 to 20,000 residents with high obesity rates and other health disparities. Community coalitions planned and implemented strategies in each community. A population-dose approach and pre and post surveys were used to assess impact of policy, program, and environmental change strategies; the analysis was conducted in 2016. Population dose is the product of reach (number of people affected by a strategy divided by target population size) and strength (the effect size or relative change in behavior for each person exposed to the strategy).
More than 230 community change strategies were implemented over 3 years, encompassing policy, environmental, and programmatic changes as well as efforts to build community capacity to sustain strategies and make changes in the future. Positive population-level results were seen for higher-dose strategies, particularly those targeting youth physical activity. Higher-dose strategies were more likely to be found in communities with the longest duration of investment.
These results demonstrate that strong (high-dose), community-based obesity prevention strategies can lead to improved health behaviors, particularly among youth in school settings.
This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.
Photovoice is a community-based participatory research method that provides participants who traditionally have little voice in community policy decisions, with training in photography, ethics, ...critical dialogue, photo captioning, and policy advocacy. Photovoice has been used primarily as a needs assessment and advocacy tool and only rarely as a pre-/postintervention evaluation method. This article describes the use of Photovoice as a participatory evaluation method in the Community Health Initiative, a 6-year, multisite community-based obesity prevention initiative, sponsored by Kaiser Permanente. Fifty community participants (including six youth) from six Community Health Initiative communities used photos and captions to identify, from their perspective, the most significant accomplishments from the initiative at both baseline and follow-up. Accomplishments identified included increased access to fresh/healthy food in local neighborhoods; policy changes supporting a "healthy eating, active living" community; increased access to physical activity; changes to the built environment creating increased neighborhood walkability/safety; and leadership development.
The recognition of the role of the environment in contributing to the obesity epidemic has led to increasing efforts to address obesity through environmental or place-based approaches in the past ...decade. This has challenged the use of the quasi-experimental design for evaluating community interventions. The objective of this study is to describe the development of an index of dose of exposure to community interventions that impact early childhood obesity. The goal is to provide an alternative means for evaluating the impact of multiple intervention strategies that target the same community at the same time. Two workgroups developed domains, constructs and protocols for estimating a “community intervention dose index” (CIDI). Information used to develop the protocol came from multiple sources including databases and reports of major funding organizations on obesity-related interventions implemented in Los Angeles County from 2005 to 2015, key informant interviews, and published literature. The workgroups identified five domains relevant to the consideration of dose of exposure to interventions: physical resources, social resources, context, capacity development, and programs and policies; developed a system for classifying programs and policies into macro- and micro-level intervention strategies; and sought ratings of strategy effectiveness from a panel of 13 experts using the Delphi technique, to develop an algorithm for calculating CIDI that considers intervention strength, reach and fidelity. This CIDI can be estimated for each community and used to evaluate the impact of multiple programs that use a myriad of intervention strategies for addressing a defined health outcome.
•Developed a system for classifying strategies into macro- and micro-level strategies•The Delphi technique was used to seek expert opinion on strategy effectiveness.•Effectiveness, reach, and fidelity used to estimate community intervention dose index•An index can be used to evaluate the impact of dose of community interventions.
We provide an overview of the Kaiser Permanente Community Health Initiative--created in 2003 to promote obesity-prevention policy and environmental change in communities served by Kaiser ...Permanente-and describe the design for evaluating the initiative. The Initiative focuses on 3 ethnically diverse northern California communities that range in size from 37,000 to 52,000 residents. The evaluation assesses impact by measuring intermediate outcomes and conducting pre- and posttracking of population-level measures of physical activity, nutrition, and overweight.
Summary
Background
Little is known about whether characteristics of communities are associated with differential implementation of community programmes and policies to promote physical activity and ...healthy eating. This study examines associations between community characteristics (e.g. region and race/ethnicity) and the intensity of community programmes and policies implemented to prevent childhood obesity. It explores whether community characteristics moderate the intensity of community efforts to prevent childhood obesity.
Objective
The objective of this study is to investigate associations between community characteristics and the intensity of community policies and programmes to prevent childhood obesity documented in the Healthy Communities Study that engaged a diverse sample of US communities.
Method
Programmes and policies were documented in 130 communities across the USA, reporting over 9000 different community programmes and policies to prevent obesity among children ages 4–15. We examined associations between community characteristics and the intensity of community programmes and policies implemented (i.e. their amount and reach, duration and strength of change strategy).
Conclusion
Community characteristics explain 25% of the variability in the intensity of community programmes and policies implemented in communities. Particular characteristics – urbanicity, region, being a large county and the per cent of African–Americans in a community – contributed to more (over 18% of the 25%) of the observed variability.
What is already known about this subject?
Childhood obesity is a critical public health challenge facing communities in the United States.
Community characteristics are associated with community health outcomes.
Previous community‐level interventions to reduce children's BMI have yielded modest and inconsistent outcomes.
What this study adds?
This study adds to our understanding of whether and how community characteristics are associated with differential implementation of community programmes and policies to address childhood obesity.
Measurement of the intensity of community‐level programmes and policies in a large and diverse sample of U.S. communities with different community characteristics.
This article is part of the supplement: The Healthy Communities Study: Examining Community Programs, Policies and Other Characteristics in Relation to Child Weight, Diet, and Physical Activity
Despite growing support among public health researchers and practitioners for environmental approaches to obesity prevention, there is a lack of empirical evidence from intervention studies showing a ...favorable impact of either increased healthy food availability on healthy eating or changes in the built environment on physical activity. It is therefore critical that we carefully evaluate initiatives targeting the community environment to expand the evidence base for environmental interventions. We describe the approaches used to measure the extent and impact of environmental change in 3 community-level obesity-prevention initiatives in California. We focus on measuring changes in the community environment and assessing the impact of those changes on residents most directly exposed to the interventions.
Purpose.
To describe the evaluation findings and lessons learned from the Kaiser Permanente Healthy Eating Active Living–Community Health Initiative.
Design.
Mixed methods design: qualitative case ...studies combined with pre/post population-level food and physical activity measures, using matched comparison schools for youth surveys.
Setting.
Three low-income communities in Northern California (combined population 129,260).
Subjects.
All residents of the three communities.
Intervention.
Five-year grants of $1.5 million awarded to each community to support the implementation of community- and organizational-level policy and environmental changes. Sectors targeted included schools, health care settings, worksites, and neighborhoods.
Measures.
Reach (percentage exposed) and strength (effect size) of the interventions combined with population-level measures of physical activity (e.g., minutes of physical activity) and nutrition (e.g., fruit and vegetable servings).
Analysis.
Pre/post analysis of population level measures, comparing changes in intervention to comparison for youth survey measures.
Results.
The population-level results were inconclusive overall, but showed positive and significant findings for four out of nine comparisons where “high-dose” (i.e., greater than 20% of the population reached and high strength) strategies were implemented, primarily physical activity interventions targeting school-age youth.
Conclusion.
The positive and significant changes for the high-dose strategies suggest that if environmental interventions are of sufficient reach and strength they may be able to favorably impact obesity-related behaviors.
When planning and evaluating community-level initiatives focused on policy and environment change, it is useful to have estimates of the impact on behavioral outcomes of particular strategies (e.g., ...building a new walking trail to promote physical activity). We have created a measure of estimated strategy-level impact—“population dose”—based on our work in evaluating obesity prevention initiatives that uses elements of the RE-AIM method of combining reach and effectiveness to estimate the impact of a strategy on risk behaviors within a target population. We provide a definition and examples of measuring population dose, discuss measurement options in the face of uncertainty about key parameters, review ways of increasing population dose, and illustrate how the concept of population dose has been used in the Kaiser Permanente Community Health Initiative.
In the last decade, many US cities, counties, and neighborhoods began implementing community-level initiatives to prevent obesity, systematic efforts targeting a specific geographic area with a ...portfolio of strategies at multiple levels and across multiple sectors. Typically, these efforts have focused on implementing policy and environmental changes related to food and physical activity focusing on specific populations, complemented by supporting programs and promotions.
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