Levels of Community Change: A Game to Teach About Policy, System, and Environment Change

Abstract

Health promotion organizations increasingly encourage multilevel, multisector interventions, because such approaches can produce more widespread and sustainable impacts than individual behavior change efforts alone. 1 Bunnell R. O'Neill D. Soler R. et al. Fifty communities putting prevention to work: accelerating chronic disease prevention through policy, systems, and environmental change. J Community Health. 2012; 37: 1081-1090 Crossref PubMed Scopus (176) Google Scholar Many public health agencies and foundations recommend or require that funded projects include policy, system, and environment (PSE) change activities. Growing numbers of health coalitions and youth advocacy programs inspire members to implement community-level changes. The Cooperative Extension System, which includes the 4-H Youth Development Program, has adopted a National Framework for Health and Wellness 2 Braun B. Bruns K. Cronk L. et al. Cooperative extension's national framework health and wellness. http://www.aplu.org/members/commissions/food-environmentand-renewable-resources/CFERR_Library/national-framework-for-health-and-wellness/fileDate: 2014 Date accessed: February 1, 2017 Google Scholar calling for strategies informed by the social ecological model (SEM) principle that behavior is influenced by multiple interacting factors. 3 Sallis J.F. Cervero R.B. Ascher W. et al. An ecological approach to creating active living communities. Annu Rev Public Health. 2006; 27: 14.1-14.26 Crossref Scopus (2053) Google Scholar , 4 Sallis J.F. Glanz K. Physical activity and food environments: solutions to the obesity epidemic. Milbank Q. 2009; 87: 123-154 Crossref PubMed Scopus (487) Google Scholar , 5 Sallis J.F. Owen N. Ecological models of health behavior. in: Glanz K. Rimer B.K. Viswanath K. Health Behavior: Theory, Research, and Practice. 5th ed. Jossey-Bass, San Francisco, CA2015: 43-64 Google Scholar , 6 Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996; 10: 282-298 Crossref PubMed Scopus (1707) Google Scholar In reality, however, practitioners often lack familiarity with and confidence in applying PSE change strategies or find terms such as policy change daunting. 7 Smathers C.A. Lobb J.M. Extension professionals and community coalitions: professional development opportunities related to leadership and policy, system, and environment change. J Extension. 2015; 53 (6FEA1)https://www.joe.org/joe/2015december/a1.phpDate accessed: June 2, 2017 Google Scholar Recognizing that educational games convey and reinforce knowledge, 8 Magnus M. Nutritional science jeopardy. J Nutr Educ Behav. 2005; 37: 159-160 Abstract Full Text PDF PubMed Scopus (2) Google Scholar , 9 Person A.L. Colby S.E. Eubanks J.W. Nutritionopoly: let healthy choices “monopolize” your lifestyle. J Nutr Educ Behav. 2011; 43: 303-305 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar an interactive game was developed to help practitioners identify various PSE strategies, understand basic tenets of the SEM, and explore ways to initiate PSE changes. Feedback from 94% of 118 nutrition educators who engaged in the game (n = 111) supports the efficacy of the game in meeting these objectives and points to the feasibility of its use with various groups.