Peer Reviewed: A Midpoint Process Evaluation of the Los Angeles Basin Racial and Ethnic Approaches to Community Health Across the US (REACH US) Disparities Center, 2007-2009

Background

Racial/ethnic minority groups have higher risks for disease resulting from obesity.

Community Context

The University of California, Los Angeles, and the Los Angeles County Department of Public Health partnered with community organizations to disseminate culturally targeted physical activity and nutrition-based interventions in worksites.

Methods

We conducted community dialogues with people from 59 government and nonprofit health and social service agencies to develop wellness strategies for implementation in worksites. Strategies included structured group exercise breaks and serving healthy refreshments at organizational functions. During the first 2 years, we subcontracted with 6 community-based organizations (primary partners) who disseminated these wellness strategies to 29 organizations within their own professional networks (secondary worksites) through peer modeling and social support. We analyzed data from the first 2 years of the project to evaluate our dissemination approach.

Outcome

Primary partners had difficulty recruiting organizations in their professional network as secondary partners to adopt wellness strategies. Within their own organizations, primary partners reported significant increases in implementation in 2 of the 6 core organizational strategies for promoting physical activity and healthy eating. Twelve secondary worksites that completed organizational assessments on 2 occasions reported significant increases in implementation in 4 of the 6 core organizational strategies.

Interpretation

Dissemination of organizational wellness strategies by trained community organizations through their existing networks (train-the-trainer) was only marginally successful. Therefore, we discontinued this dissemination approach and focused on recruiting leaders of organizational networks.     

Enabling transformational change: the Ontario shores experience

This case study outlines key considerations for healthcare organizations experiencing significant transformational change, based on the experience of Ontario Shores Centre for Mental Health Sciences (Ontario Shores), formerly Whitby Mental Health Centre. Significant systemic change requires specific and intentional efforts from the leaders tasked with carrying out transformational activities. This article presents the perspectives of leaders involved in the transformation of Ontario Shores as it moved from a government-based agency to a stand-alone specialty psychiatric hospital in 2006. During this time, several conventional strategies were employed to manage the transition, but various critical approaches also emerged that assisted the organization to effect significant change and achieve marked improvements over key evaluation metrics. These critical strategies included maximizing the distinct and collective roles of governance and leadership; balancing strategy and action through a culture of accountability; leveraging strategic communication opportunities; and shifting the organizational mindset.     

Recreating communities to support active living: a new role for social marketing

The lack of routine physical activity has become an all too pervasive health threat in the United States. Social marketing can be used directly to promote increased physical activity among people who have access to active living options (e.g., safe and convenient sidewalks or bike paths). A second, albeit indirect, use of social marketing to promote physical activity--and the focus of this article--involves promoting behaviors that influence the built environment for the purpose of increasing people's access to active living options. This use of social marketing involves changing the behavior of consumers, developers, distribution channels (e.g., real estate agents) and policy makers. The approach offers public health and other organizations a disciplined, consumer-focused means of mobilizing their available resources in a manner that maximizes the odds of creating active living communities. These means include understanding the competition, understanding target markets, creating mutually beneficial exchanges, segmenting markets and targeting them based on anticipated return. This article identifies specific opportunities for applying the social marketing approach to create active living communities, and identifies opportunities at the state and national level that will enhance the effectiveness of local efforts.     

How to Identify Success Among Networks That Promote Active Living

Objectives. We evaluated organization- and network-level factors that influence organizations’ perceived success. This is important for managing interorganizational networks, which can mobilize communities to address complex health issues such as physical activity, and for achieving change.Methods. In 2011, we used structured interview and network survey data from 22 states in the United States to estimate multilevel random-intercept models to understand organization- and network-level factors that explain perceived network success.Results. A total of 53 of 59 “whole networks” met the criteria for inclusion in the analysis (89.8%). Coordinators identified 559 organizations, with 3 to 12 organizations from each network taking the online survey (response rate = 69.7%; range = 33%–100%). Occupying a leadership position (P < .01), the amount of time with the network (P < .05), and support from community leaders (P < .05) emerged as correlates of perceived success.Conclusions. Organizations’ perceptions of success can influence decisions about continuing involvement and investment in networks designed to promote environment and policy change for active living. Understanding these factors can help leaders manage complex networks that involve diverse memberships, varied interests, and competing community-level priorities.Interorganizational networks, including coalitions, community collaboratives, and partnerships,1 are formed throughout the public health sector as a mechanism for mobilizing communities to address complex health issues.2 Public health professionals, planning officials, and community-based organizations each bring unique resources to networks, while possessing inherently distinctive organizational goals.3A key aspect of networks is the ability of community partners to work together to reach goals that cannot be achieved by an organization acting alone.4 Networks offer many advantages—assembling diverse stakeholders, pooling resources, and increasing organizational capacity to achieve goals.5–7 This approach allows organizations within networks to develop “cognitive capability” or joint learning, which enhances capacity building to achieve desired results.8 Goal congruence among organizations is thought to be essential because when individual organizational goals are aligned with the group’s goals, organizations are more likely to commit time and resources to the group.3,5,6 A diverse membership, comprising both formal and informal partners from a range of sectors, can bring resources and political support to the group, increasing the group’s success.9 Engaging with policymakers and public officials to garner support for collaborative activities increases both the visibility of the network and the likelihood of success.10–12Although diversity in network expertise and resources is cited as essential for collaborative advantage,5 it has been suggested that too much heterogeneity can complicate group effectiveness.3 This caveat has implications for public health practice. Specifically, data about how networks develop and function can inform stakeholders involved in interorganizational networks including government, practitioners, and funders about how to build, manage, and evaluate effective networks. A growing expectation today for public health personnel is that they engage in partnerships with other organizations, particularly outside public health, as a way to achieve stated goals. Although engaging in partnerships has long been a predominant activity for public health personnel,13 the extent to which collaboration is expected today seems to be reaching levels greater than in the past.14–17 O’Leary et al. noted that

public managers now find themselves not as unitary leaders of unitary organizations . . . instead they find themselves convening, facilitating, negotiating, mediating, and collaborating across boundaries.18^(p8)

Moreover, within the public health sector, there is little guidance on how public health personnel might consider the cost of this new expectation, or an evidence base to inform how they might manage the complex relationships that come with increased collaboration.19,20Interorganizational networks have become essential in the area of physical activity promotion. Physical activity levels across the US population remain insufficient with only 20.6% of adults aged 18 years and older meeting national guidelines for both aerobic and muscle-strengthening physical activity.21 Public health systems are attempting to address the decline in physical activity by reshaping the environment to promote active transportation and active lifestyles. Collaborations among organizations from diverse sectors including public health, planning, transportation, public works, parks and recreation, schools, city government, and community-based organizations are being forged to develop policy and built environment solutions to promote active lifestyles.22–25Although the prevalence of interorganizational networks has risen rapidly, little is known about their effectiveness in creating lasting change.10,26,27 Insight into these relationships will enable community networks to be more strategic in their involvement of partners and use of various tactics and activities to achieve system-level changes, including policy and related environmental improvements. The present analysis is part of the Coalitions and Networks for Active Living study from the Physical Activity Policy Research Network, a thematic research network of the Centers for Disease Control and Prevention. We aimed to characterize active living collaboratives (operationalized as interorganizational networks) by identifying organization- and network-level factors associated with networks’ effectiveness in advancing related environmental improvements and policies.10,22,28     

Community Mobilization to Promote and Protect the Sexual and Reproductive Rights of Women Living with HIV in Latin America

Between 2009 and 2014, the International Community of Women Living with HIV in Latin America and the Mexican feminist civil society organization Balance coordinated a five-country community-led intervention that brought together women living with HIV (WLHIV), trans women, sex workers, and feminist lawyers to document and respond to sexual and reproductive health and rights (SRHR) violations of WLHIV and advocate for legal, policy, and programmatic changes to fulfill SRHR. The experiences of involved community leaders (n=26) indicate that knowledge of national, regional, and international human rights commitments and up-to-date medical information positively influenced personal health behaviors, empowered WLHIV as subject matter experts, and emboldened them to hold duty-bearers to account. The research evidence generated through collective action was critical for legitimating SRHR violations of WLHIV with decision-makers and for positioning the issue in the advocacy agendas of national and regional HIV and women’s movements. Collective action contributed to social cohesion among diverse groups of women living with and affected by HIV and increased available technical, financial, and organizational resources and political opportunities by linking organizations and networks. Collectively, community leaders mobilized to influence policy, legal frameworks, and service delivery to promote and protect the SRHR of WLHIV.     

An examination of eating attitudes and physical activity levels of Turkish university students with regard to self-presentational concern

This study aimed to examine eating attitudes and physical activity level of young women and men university students with regard to social physique anxiety level. 482 university students participated in this study voluntarily. “Eating Attitude Test (EAT-40)”, “Social Physique Anxiety Scale” and “Physical Activity Assessment Questionnaire” were used to assess the eating attitude, social physique anxiety and physical activity level of participants, respectively. Women and men participants in this study were assigned to high (HSPA) and low (LSPA) social physique anxiety groups with respect to their median scores. Men had favorable eating attitudes and higher physical activity level than women. In addition, participants in the HSPA group had unfavorable eating attitudes and higher physical activity MET values than participants in the LSPA group. On the other hand, group × gender interaction was only significant for the eating attitudes scores but, not for physical activity level. Women in the HSPA group scored higher on the EAT-40 than men in HSPA and women and men in the LSPA groups.     

Do I Just Look Stressed or am I Stressed? Work-related Stress in a Sample of Italian Employees

Work-related stress is becoming a significant problem in Italy and it is therefore essential to advance the theory and methodology required to detect this phenomenon at work. Thus, the aim of this paper is to propose a new method for evaluating stress at work by measuring the discrepancies between employees’ perceptions of stress and their leaders’ evaluation of the stress of their subordinates. In addition, a positive impression scale was added to determine whether workers might give socially desirable responses in organizational diagnosis. Over 1,100 employees and 200 leaders within several Italian organizations were involved in this study. Structural equation modeling was used to test such new method for evaluating stress in a model of stress at work that incorporates relationships among individual (positive impression), interpersonal (workplace bullying) and organizational factors (working conditions, welfare culture, training). Results showed that the leaders’ capacity to understand subordinates’ stress is associated with subordinates’ psychological well-being since higher disagreement between self and leaders’ ratings was related to lower well-being. We discuss the implications of healthy leadership for the development of healthy organizations.     

The Influence of Neighborhood Social Capital on Leisure-Time Physical Activity: a Population-Based Study in Brazil

Environmentally targeted approaches to promote physical activity are emerging in recent years as a complementary strategy to the traditional individual approaches. This study explored the relation between community social capital and leisure-time physical activity in an adult population-based sample in Brazil. We applied a generalized estimating equation approach to analyze a cross-sectional survey of 3667 adults living in 149 neighborhoods. Social capital was assessed by scales that measured collective efficacy and social cohesion in the neighborhood. We find that individuals living in areas with higher level of social cohesion were more likely to be physically active even after controlling for potentially confounding individual and area-level covariates (PR?=?1.56; 95% CI?=?1.13, 2.16). Collective efficacy was not significantly associated with leisure-time physical activity. Interventions to strengthen social cohesion in the community may be an avenue for promoting physical activity.     

Developing organizational learning in the NHS

Learning has been identified as a central concern for a modernized NHS. Continuing professional development has an important role to play in improving learning but there is also a need to pay more attention to collective (organizational) learning. Such learning is concerned with the way organizations build and organize knowledge. Recent emphasis within the NHS has been on the codification of individual and collective knowledge - for example, guidelines and National Service Frameworks. This needs to be balanced by more personalized knowledge management strategies, especially when dealing with innovative services that rely on tacit knowledge to solve problems. Having robust systems for storing and communicating knowledge is only one part of the challenge. It is also important to consider how such knowledge gets used, and how routines become established within organizations that structure the way in which knowledge is deployed. In many organizations these routines favour the adaptive use of knowledge, which helps organizations to achieve incremental improvements to existing practices. However, the development of organizational learning in the NHS needs to move beyond adaptive (single loop) learning, to foster skills in generative (double loop) learning and meta-learning. Such learning leads to a redefinition of the organization's goals, norms, policies, procedures or even structures. This paper argues that moving the NHS in this direction will require attention to the cultural values and structural mechanisms that facilitate organizational learning.     

Individual and institutional influences on faith-based health and wellness programming

The majority of the US population is affiliated with faith-based organizations (FBO). Health and wellness activities (HWAs) within FBOs have great potential for reach, though the factors influencing faith-based HWA are not well understood. The purpose of this study was to examine individual faith leader and institutional influences on HWAs offered within FBOs. A national convenience sample of faith leaders (N = 844) completed an online survey assessing individual (demographics, health, health behaviors and attitudes) and institutional influences (size, location and external support) on health and HWA within FBO. Respondents were primarily White (93%), male (72%), middle-aged and affiliated with Methodist (42.5%) or Lutheran (20.2%) religions. Respondents reported 4.8 ± 3.2 HWA within their FBO per year. Faith leader education, length of service to the FBO, physical activity and fruit/vegetable intake were positively related to HWA and body mass index was negatively related. Denomination, congregation diversity, location and size were also related to HWA. Results show a strong relationship between faith leaders' health and HWA, indicating the influence of the social environment on health promotion in FBOs. Institutional variables, though not modifiable, were significant predictors of HWA and should be considered when delivering interventions to achieve a significant impact.     

Adolescents encouraging healthy lifestyles through a peer‐led social marketing intervention: Training and key competencies learned by peer leaders

BackgroundAdolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience.ObjectivesTo identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies.DesignThe present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries.Setting and ParticipantsEighteen peer leaders (aged 13–15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers.MeasuresThe peer leaders'' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study.ResultsThe peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries.ConclusionThe peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size.Patient or Public ContributionThe peer leaders contributed to the design and implementation of the training and intervention.     

Indicators of activity-friendly communities: an evidence-based consensus process

BACKGROUND: Regular physical activity, even at modest intensities, is associated with many health benefits. Most Americans, however, do not engage in the recommended levels. As practitioners seek ways to increase population rates of physical activity, interventions and advocacy efforts are being targeted to the community level. Yet, advocates, community leaders, and researchers lack the tools needed to assess local barriers to and opportunities for more active, healthy lifestyles. Investigators used a systematic review process to identify key indicators of activity-friendly communities that can assess and improve opportunities for regular physical activity. METHODS: Investigators conducted a comprehensive literature review of both peer-reviewed literature and fugitive information (e.g., reports and websites) to generate an initial list of indicators for review (n=230). The review included a three-tiered, modified Delphi consensus-development process that incorporated input of international, national, state, and local researchers and practitioners from academic institutions, federal and state government agencies, nonprofit organizations, and funding agencies in public health, transportation, urban planning, parks and recreation, and public policy. RESULTS: Ten promising indicators of activity-friendly communities were identified: land use environment, access to exercise facilities, transportation environment, aesthetics, travel patterns, social environment, land use economics, transportation economics, institutional and organizational policies, and promotion. CONCLUSIONS: Collaborative, multidisciplinary approaches are underway to test, refine, and expand this initial list of indicators and to develop measures that communities, community leaders, and policymakers can use to design more activity-friendly community environments.     

International perspectives on the physical inactivity crisis—Structural solutions over evidence generation?

Many programs to increase physical activity have been evaluated in developed countries, where ‘leisure time physical activity’ is the most frequent domain for interventions. In developing countries, and also with reference to global obesity prevention, different kinds of interventions targeting ‘total physical activity’ are needed. This requires efforts across agencies and sectors, and in the domains of work, active transport, reduced sitting time, as well as leisure time physical activity promotion. In considering possible solutions, this commentary examined the use of complex systems, where integrated efforts across sectors and agencies might, in combination, contribute to increasing total physical activity. The key sets of actions required globally to increase physical activity were, in our opinion, [i] efforts to disseminate individual-level behavior change programs to reach much larger populations rather than volunteers, [ii] social marketing and mass communication campaigns to change social norms in the community and among professionals and policymakers, [iii] efforts to influence the social and physical environment to make them more conducive to physical activity, and [iv] the development and implementation of national physical activity plans and strategies, with sufficient timelines and resources to achieve measurable change.     

Peer Reviewed: Multisector Partnerships in Population Health Improvement

Many new initiatives for population health improvement feature partnerships of leaders and organizations across multiple sectors of society. The purpose of this article is to review 1) the rationale for such partnerships as an important, if not essential, tool for population health improvement; 2) key organizational and contextual factors that appear to be associated with effective multisector partnerships; and 3) the limited evidence regarding the effect of such partnerships on population health outcomes. We conclude that systems thinking — accounting for the collective effect of many actors and actions — is essential to organizing and sustaining efforts to improve population health, and to evaluating them. More research is needed to understand how and why multisector partnerships are formed and sustained and the conditions under which multisector partnerships are necessary or more effective than other strategies for population health improvement. Research on and evaluation of multisector partnerships also need to incorporate more standard measures of partnership contexts, characteristics, and strategies and adopt longitudinal and prospective designs to accelerate social learning in this area. Finally, studies of multisector partnerships must be alert to the value of such initiatives to individuals and communities apart from any direct and measurable impact on population health.     

Bridging the gap. Catholic health care organizations need concrete ways to connect social principles to practice

Establishing and maintaining institutional identity is a challenge for leaders in Catholic health care. A process known as "progressive articulation" can be used to help leaders assess how well their organizations reflect Catholic social tradition and help them apply this tradition toward specific organizational practices. The particular approach described here is called the "Identity Inquiry and Improvement Process" (31P), and it takes Catholic social principles and translates them into criteria and benchmarks for assessing an organization's interactions with internal and external stakeholders. In other words, 31P seeks to make mission measurable and concrete.     

Patterns of targeting and encouraging participation of elder consumers in human services marketing

Competition within the older adult services sector is fueling the widespread adoption of an organizational marketing mentality. Yet little is known of the degree of variation in marketing technology and commitment to elder consumer subgroups in different health and social service settings or the extent to which elders are involved actively in the marketing process. This paper addresses these issues drawing on study data collected from 274 elder service programs in six major U.S. metropolitan areas. Findings confirm that providers frequently co-market their services with other organizations and target multiple constituencies, but do not distinguish as well among specialized segments of the elder population varying in terms of gender, physical and mental capacity, age, financial status, or race. Significant predictors (p<.05) of increased levels of elder participation in the agency marketing pro cess include length of time marketing, specialized training in marketing, and nonsectarian auspice (R2=.22). Results lead to recommendations for mounting more cohort-sensitive marketing initiatives in human service agencies serving older adults.     

The Dutch heart health community intervention 'Hartslag Limburg': results of an effect study at organizational level

BACKGROUND: 'Hartslag Limburg', a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high-risk strategy to reduce CVD risk behaviours. This article presents the results of the effect evaluation study of the community intervention at the organizational level. Organizational changes were an intermediate goal of the Hartslag Limburg community intervention, as these are assumed to be a prerequisite for changes at the individual level. METHODS: A baseline-post-test control group design was used. The baseline measurement was conducted in 1998 and the post-test measurement in 2001. At baseline, 700 organizations were selected in the Maastricht region, and 577 in a control region. All organizations that were potentially significant agents in health-promoting activities were included. Data on organizational involvement in health-promoting activities were gathered by means of structured questionnaires, and sent to organization representatives by mail. RESULTS: The overall post-test percentage of organizations involved in at least one activity relating to physical activity was higher in the Maastricht region than in the control region. Furthermore, the number of activities per organization involved in activities relating to healthy eating, smoking behaviour or physical activity was higher in the Maastricht region than in the control region at post-test. CONCLUSIONS: This study provided valuable information about organizational involvement in health-promoting activities, as well as important information to consider in future research in this area. Due to the limitations of the study, the importance of measuring change at different social levels in community-based programmes, and the scarcity of effect studies of community interventions at the organizational level, further research on this subject is warranted.     

Collective Efficacy and Obesity-Related Health Behaviors in a Community Sample of African Americans

The social environment is important to body mass index and obesity. However, it is unknown if perceptions of the social environment are associated with obesity-related behaviors in populations at greatest risk for being overweight or obese. We evaluated the relationship between collective efficacy and diet and physical activity in a community-based sample of African American adults who were residents in an urban area. Data were collected as part of an academic-community partnership from November 2009 to 2011. We evaluated whether participants met the recommended guidelines for diet and physical activity based on collective efficacy and their sociodemographic background, health care variables, and self-efficacy in a community-based sample of African American adults (n = 338) who were residents in the Philadelphia, PA metropolitan area. Overall, many participants did not meet the recommended guidelines for fruit and vegetable intake or physical activity. The likelihood of meeting the recommended guidelines for fruit intake increased with greater levels of collective efficacy (OR 1.56, 95 % CI 1.18, 2.07, p = 0.002) and self-efficacy for diet (OR 1.56, 95 % CI 1.19, 2.04, p = 0.001). Collective efficacy was not associated with physical activity and the positive association between collective efficacy and vegetable intake was not statistically significant (OR 1.25, 95 % CI 0.94, 1.65, p = 0.12). It is important to determine the most effective methods and settings for improving diet and physical activity behaviors in urban African Americans. Enhancing collective efficacy may be important to improving adherence to recommended guidelines for obesity-related health behaviors.     

Peer Reviewed: A Community–School District–University Partnership for Assessing Physical Activity of Tweens

Introduction

Obesity among youth is related to a decline in physical activity, and data on physical activity levels among children in elementary and middle schools are limited.

Methods

We leveraged a community–school district–university partnership in Sarasota County, Florida, in May of 2005 to assess physical activity levels among tweens (youth aged 9-13 years) and to measure the relationship between tweens'' awareness of the Centers for Disease Control and Prevention''s VERB program and participation in physical activity, using a minimally obtrusive survey. After surveying participating schools (4 elementary schools and 3 middle schools), we obtained 1,407 responses from children in grades 5 through 7.

Results

In all, 83.1% of students met the federal recommendation for daily participation in vigorous-intensity physical activity (VPA), and 58.6% had tried a new game or sport within the previous 2 months. Mean number of days in the previous week engaging in VPA was significantly higher (P < .001) for boys (5.22) than for girls (4.35). Mean number of days engaging in VPA in the previous week was significantly higher (P = .006) among 6th-grade students (4.93) than 7th-grade students (4.54), but no consistent decline through the grade levels occurred. Activity was significantly correlated with the number of friends reported as playing a game or sport daily (r = .369, P < .001). Most students (88.8%) reported having seen, read, or heard messages or ads about VERB, a tween-centric national social marketing campaign promoting physical activity and participation in new games and sports.

Conclusion

Although participation in VPA was high, girls reported significantly fewer days spent engaged in VPA than did boys. We found a modest association between engaging in VPA and having active friends. Capitalizing on leadership from multiple community-based organizations to monitor youth physical activity may inspire implementation of strategies for motivating youth to try new games and sports that they can sustain through the adolescent years and beyond.