Using Population Dose to Evaluate Community-level Health Initiatives

Harner, Lisa T.; Kuo, Elena S.; Cheadle, Allen; Rauzon, Suzanne; Schwartz, Peter H.; Parnell, Barbara; Kelly, Cheryl; Solomon, Loel

doi:10.1016/j.amepre.2018.01.026

Cited by 12 publications

(16 citation statements)

References 22 publications

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“…Program coordinators and evaluators who are interested in using dose for planning and implementation can learn more about dose from a National Academy of Medicine white paper 10 and find more detailed methods, tools, and resources in the online dose toolkit 9 and articles included in this special issue. 11,12 Dose methods will hopefully be incorporated more in the planning and implementation phases of CHIs in order to better engage the communities in which these programs are based, and reach the highest number of community members possible. Dose methods in these early planning phases can help ensure community initiatives are maximized effectively with the most buy-in from community members, and the greatest impact on their targeted populations.…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Dose as a Tool for Planning and Implementing Community-Based Health Strategies

Kuo

Harner

Frost

et al. 2018

American Journal of Preventive Medicine

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Section: Conclusion and Recommendationsmentioning

confidence: 99%

Dose as a Tool for Planning and Implementing Community-Based Health Strategies

Kuo

Harner

Frost

et al. 2018

American Journal of Preventive Medicine

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“…There was also a negative correlation between weekend sedentary hours per day and P3E intensity score, but it was not significant (p = 0.098). Building on the RE-AIM Framework 28 and previous research, 25,26,29 higher intensity activities can lead to improved health outcomes. This study expanded upon the HCS by suggesting the number of Understanding the mechanisms of effects can help stakeholders and their funders assess whether a package of interventions is performing in the way it is intended along the full range of its implementation, rather than simply an evaluation of its ultimate impact.…”

Section: Relationship Between P3e Scores and Outcomesmentioning

confidence: 94%

“…In recent years, efforts to assess the impact of MCIs have expanded (17,(25)(26)(27)(28)(29).Largely building on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (30),many evaluations have assessed a combination of attributes among all strategies within an initiative (17,(25)(26)(27)(28)(29). Cheadle et.…”

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confidence: 99%

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities Initiative

Calise

Spitzer

Ruggiero

et al. 2019

Preprint

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Background: Little is known about the intensity of multi-component initiatives (MCI) inclusive of any combination of programs, practices, policies, and environmental changes (P3E) on youth behaviors. Methods: The Healthy Schools Healthy Communities (HSHC) initiative worked to increase access to PA opportunities as part of 33 MCIs targeting school districts and respective communities. The purpose of this study was to assess whether MCIs with higher scoring PA-related strategies were associated with improved PA and sedentary behaviors among youth. PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative); 2) duration; and 3) reach. An overall composite score of all activities was calculated for each school district. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and district enrollment. Results: P3E scores ranged from 0.3 to 3.0 with 20% considered “higher-scoring” (score > 2.1) and 47% considered “lower-scoring” ( < 1.2 ). Average composite district P3E scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average composite district P3E intensity score, the number of days per week that students reported being physically active for at least 60 minutes increased by 0.010 (p<0.01). For each additional point increase in district P3E intensity score, the number of hours per weekday that students reported engaging in screen time activities decreased by 0.006 hours (p<0.5). Conclusions: MCIs are difficult to evaluate given the variations within which they are implemented. Findings from this study suggest the value of a systematic scoring approach in assessing MCIs. In addition to tracking intensity over time, scoring can provide justification for, or against, an individual activity and ways to increase the likelihood of the MCI impacting population-health outcomes.

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“…Moreover, while funders and other stakeholders want to see population-level health improvements (e.g., reduced obesity), these changes may not be detectable in the short-term [24,25]. Efforts to assess strategies and their likely positive impact in the long-term are warranted, and have been increasingly explored [15,[26][27][28][29][30]. Cheadle et al [31], developed and assessed various attributes (e.g., reach, efficacy and strength) of single strategies, and found those with higher reach and strength were correlated with improved health behaviors [31].…”

Section: Introductionmentioning

confidence: 99%

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative

et al. 2021

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Background Although successful, assessment of multi-component initiatives (MCIs) prove to be very challenging. Further, rigorous evaluations may not be viable, especially when assessing the impact of MCIs on long-term population-level behavior change (e.g., physical activity (PA) and health outcomes (e.g., childhood obesity). The purpose of this study was to use intensity scoring, to assess whether higher intensity MCIs implemented as part of Healthy Schools Healthy Communities (HSHC) were associated with improved physical activity and reduced sedentary behaviors among youth (dependent variables). Methods PA-related interventions were assigned point values based on three characteristics: 1) purpose of initiative; 2) duration; and 3) reach. A MCI intensity score of all strategies was calculated for each school district and its respective community. Multivariate longitudinal regressions were applied, controlling for measurement period, Cohort, and student enrollment size. Results Strategy intensity scores ranged from 0.3 to 3.0 with 20% considered “higher-scoring” (score > 2.1) and 47% considered “lower-scoring” (< 1.2). Average MCI intensity scores more than tripled over the evaluation period, rising from 14.8 in the first grant year to 32.1 in year 2, 41.1 in year 3, and 48.1 in year 4. For each additional point increase in average MCI intensity score, the number of days per week that students reported PA for at least 60 min increased by 0.010 days (p < 0.01), and the number of hours per weekday that students reported engaging in screen time strategies decreased by 0.006 h (p < 0.05). An increase of 50 points in MCI intensity score was associated with an average 0.5 day increase in number of weekdays physically active and an increase of 55 points was associated with an average decrease of 20 min of sedentary time per weekday. Conclusions We found a correlation between intensity and PA and sedentary time; increased PA and reduced sedentary time was found with higher-intensity MCIs. While additional research is warranted, practitioners implementing MCIs, especially with limited resources (and access to population-level behavior data), may consider intensity scoring as a realistic and cost effective way to assess their initiatives. At a minimum, the use of intensity scoring as an evaluation method can provide justification for, or against, the inclusion of an individual strategy into an MCI, as well as ways to increase the likelihood of the MCI impacting population-health outcomes.

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Using Population Dose to Evaluate Community-level Health Initiatives

Abstract: This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.

Cited by 12 publications

References 22 publications

Dose as a Tool for Planning and Implementing Community-Based Health Strategies

Dose as a Tool for Planning and Implementing Community-Based Health Strategies

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities Initiative

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities initiative

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