Brennan Laura K, Kemner Allison L, Donaldson Kate, Brownson Ross C
Transtria LLC, St Louis, Missouri (Dr Brennan and Mss Kemner and Donaldson); Prevention Research Center in St Louis, Brown School (Dr Brownson), and Division of Public Health Sciences and Alvin J. Siteman Cancer Center (Dr Brownson), Washington University School of Medicine, Washington University in St Louis, St Louis, Missouri.
J Public Health Manag Pract. 2015 May-Jun;21 Suppl 3:S121-34. doi: 10.1097/PHH.0000000000000256.
The purpose of this article is to assess and understand the intervention reach, dose, and impact of policy, practice, and environmental changes implemented by the 49 Healthy Kids, Healthy Communities (HKHC) community partnerships across the United States and in Puerto Rico. These partnerships planned and implemented healthy eating and active living policy, system, and environmental interventions to support healthier communities for children and families, with special emphasis on reaching children at highest risk for obesity.
Using a mixed-methods, participatory evaluation design, investigators analyzed multiple qualitative and quantitative data sources collected during the HKHC initiative from 2009 to 2014. Evaluators used an inductive approach to develop indicators to assess intervention reach, dose, and impact for 6 cross-site strategies, including corner stores, farmers' markets, child care nutrition standards, child care physical activity standards, active transportation, and parks and play spaces.
Across HKHC community partnerships, 4261 policy, practice, or environmental changes occurred in 1536 intervention settings. Several trends emerged from the data related to how different levels of intervention (ie, community-level, setting-level, and within-setting), the size and access to intervention settings, the stage of implementation, and the sociodemographic composition of the intervention settings play important roles in the way policy, practice, and environmental changes "count" toward intervention reach, dose, and impact.
This exploratory analysis provided a method and typology for increasing understanding in the field related to the reach, dose, and impact of policy, practice, and environmental changes promoting healthy eating and active living in order to reduce childhood overweight and obesity.
本文旨在评估和了解美国本土及波多黎各的49个“健康儿童，健康社区”（HKHC）社区伙伴关系所实施的政策、实践及环境变化的干预覆盖范围、剂量和影响。这些伙伴关系规划并实施了健康饮食与积极生活的政策、系统及环境干预措施，以支持儿童及家庭生活在更健康的社区，特别强调惠及肥胖风险最高的儿童。
研究人员采用混合方法参与式评估设计，分析了2009年至2014年HKHC倡议期间收集的多个定性和定量数据源。评估人员采用归纳法制定指标，以评估包括街角商店、农贸市场、儿童保育营养标准、儿童保育体育活动标准、积极出行以及公园和游乐场所在内的6种跨站点策略的干预覆盖范围、剂量和影响。
在HKHC社区伙伴关系中，1536个干预场所发生了4261项政策、实践或环境变化。数据呈现出几个趋势，涉及不同干预层面（即社区层面、场所层面和场所内部）、干预场所的规模和可达性、实施阶段以及干预场所的社会人口构成如何在政策、实践和环境变化对干预覆盖范围、剂量和影响的“作用”方面发挥重要作用。
这项探索性分析提供了一种方法和类型学，以增进该领域对促进健康饮食和积极生活的政策、实践和环境变化的覆盖范围、剂量和影响的理解，从而减少儿童超重和肥胖。
