Evidence-Based Public Health Approaches to Promote Cardiometabolic Health: A Mixed Methods Study of Community Health Improvement Plans

Univ Of Massachusetts Med Sch Worcester, Worcester MA

Investigators

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Abstract

PROJECT SUMMARY/ABSTRACT Few U.S. adults and children meet established healthy eating and physical activity recommendations despite strong scientific evidence concluding these behaviors can prevent cardiometabolic conditions. Reducing the burden of cardiometabolic conditions will require innovative prevention efforts outside of the clinical arena. Policy-based public health initiatives are a promising approach, yet the implementation of public health policies into practice lags. Local health departments (LHDs) are uniquely poised to improve community health due to their awareness of local health needs and resources, but for instance only one quarter of LHDs report participating in urban design or land use policy processes. Community health improvement plans (CHIPs) represent a data-driven, collaborative, community engaged method for LHDs to identify evidence-based policies and programs, delineate resource allocations and evaluate impact in a standardized method. This emerging strategic approach is endorsed by multiple national organizations, required for public health accreditation, represents an opportunity to implement effective strategies to promote cardiometabolic health, and catalyzes cross-sector collaboration. However, the proportion and quality of local evidence-based healthy eating and physical activity policies included in CHIPs and subsequent implementation processes is understudied. A better understanding of these aspects can inform future implementation science efforts. The proposed research is aligned with NHLBI's strategic plan (6.CC.10), which identifies the need for novel methodologies for implementation research that explore uptake of research findings into approaches, programs, and policies. The proposed mixed-methods research will evaluate the content and implementation processes of evidence-based healthy eating and physical activity policies included within CHIPs developed by U.S LHDs. The specific aims are to (1a) Determine the proportion of LHD CHIPs with inclusion of specific evidence-based healthy eating and physical activity policies and (1b) Identify characteristics of LHDs associated with inclusion of evidence-based healthy eating and physical activity policies in their CHIPs using data from an ongoing national probability survey of LHD officials, administered by the UMass PRC; (2) Assess the quality of evidence-based healthy eating and physical activity policies included in CHIPs through a systematic content analysis of CHIP documents (n~100) identified by the survey (Aim 1); and (3) Assess the implementation of evidence-based healthy eating and physical activity policies in exemplar CHIPs through a multiple-case study approach of semi-structured interviews with a total of 10 key informants who facilitate the implementation of healthy eating (n=5) and physical activity (n=5) priority areas in CHIPs assessed during Aim 2. A tailored training plan accompanies this proposal and outlines the steps required to advance Ms. Sreedhara's career as an independent implementation scientist in public health policy.