PSE Changes Research Articles

Maximizing the Potential of Mini-Grants to Promote Policy, Systems, and Environmental Changes: Outcomes and Challenges.

This article describes the implementation and evaluation of a chronic disease mini-grant initiative, coordinated by a state health department in collaboration with multiple stakeholders. Braided funding from federal and state sources was used to build and implement the initiative. Mini-grants, facilitated by five different facilitating organizations, were funded to promote implementation of policy, systems, and environmental (PSE) changes at the local level. Grant recipients represented a variety of sectors, including education, government, and nonprofit organizations. Primary (surveys) and secondary (final reports) data documented achievement of PSE changes. A total of $196,369 was dispersed to 65 organizations; 126 PSE changes in the areas of physical activity, nutrition, and tobacco were reported. Challenges in implementing and evaluating mini-grants were identified, including the heterogeneity of the sectors/settings involved and associated variability of proposed activities, time lines, measurement, and evaluation activities. COVID-19 (coronavirus disease 2019) also disrupted the plans for many projects. The success of this initiative can be attributed to four main elements: (1) the use of intermediary organizations to facilitate the mini-grants; (2) a participatory evaluation process, combined with early and ongoing communication among all stakeholders; (3) a braided funding strategy; and (4) a multisector approach that engaged both traditional and nontraditional public health organizations. The processes and outcomes, including challenges, can inform other state health departments' efforts in braiding funding and engaging intermediary organizations to expand the reach of PSE changes at the local level.

P95 Process and Outcome Evaluation of the LSU AgCenter SNAP-Ed Program Using Microsoft Dynamics 365

<h3>Background</h3> Supplemental Nutrition Assistance Program Education (SNAP-Ed) encourages healthier eating through education and policy, systems, and environmental (PSE) changes to support access to healthier foods. Collecting and managing data for process and outcome evaluations is challenging for SNAP-Ed implementing agencies (IAs) with variation in direct education and PSE change projects implemented. Several IAs have used the Program Evaluation and Reporting System (PEARS) to gather and manage evaluation data, but this may be cost prohibitive for IAs with smaller budgets. The LSU AgCenter Information Technology (IT) department adapted Microsoft Dynamics 365 to the evaluation needs of the LSU AgCenter SNAP-Ed program. <h3>Objective</h3> To conduct a process evaluation of direct education and PSE change work conducted by the LSU AgCenter SNAP-Ed program in Federal Fiscal Year 2019-2020 using the Microsoft Dynamics 365 Application. <h3>Study Design, Setting, Participants</h3> LSU AgCenter IT staff adapted Dynamics to collect the data necessary to report against priority indicators in the SNAP-Ed evaluation framework. IT staff created separate reporting modules for individual direct education contacts, groups of direct education contacts, community partnerships, community coalitions, and PSE changes. SNAP-Ed frontline staff were trained on the reporting system in a series of hands-on, in-person meetings held prior to March 2020. <h3>Measurable Outcomes/Analysis</h3> LSU AgCenter staff report direct education contacts, partnerships, coalitions, and PSE changes made in the Microsoft Dynamics application. Data can be disaggregated according to demographic information, location, and implementing staff member, enabling data to be used in performance evaluations and analyses of equity in program access. <h3>Results</h3> Feedback about the reporting system was overwhelmingly positive. The system collected data necessary for reporting to state and federal funding agencies. Over the course of FY2020, LSU AgCenter established 502 partnerships, made 6,473 direct education contacts, and 118 PSE changes. <h3>Conclusion</h3> The Microsoft Dynamics 365 Application was easily adapted to the evaluation needs of the LSU AgCenter SNAP-Ed program. Process and outcome evaluation data indicated that the LSU AgCenter met its goals for FY2020.

P37 Theory of Planned Behavior Describes Oklahoma Cooperative Extension Educators’ Intent to Use PSE Approaches

<h3>Background</h3> A nation-wide focus on Policy, Systems, and Environmental (PSE) strategies has emerged as a complimentary approach to individual based strategies for obesity prevention. PSE changes are community-based and aim to create environments that facilitate healthy eating and physical activity to support prevention of obesity and related chronic disease. Efforts are often planned and implemented through collaborative efforts with agencies, such as Cooperative Extension and community partners. <h3>Objective</h3> Use a previously established survey to determine factors affecting Oklahoma Cooperative Extension Educators' (OCEE) intentions to use PSE strategies as an approach to address public health issues in local communities. <h3>Study Design, Setting, Participants</h3> The cross-sectional study used a 66-item online survey administered to OCEE working in the areas of Family and Consumer Sciences, SNAP-Ed/EFNEP, 4-H and Agriculture. <h3>Analysis</h3> Principal component factor analysis with oblique rotation analyzed 52 items describing factors related to use of PSE strategies. Factor loadings >0.05 were retained. Cronbach alpha ≥0.70 was used to determine internal consistency. Frequency analysis of the remaining 14 items described beliefs related to obesity and related chronic disease, demographic and employment characteristics of the responding OCEE. <h3>Results</h3> Obesity, diabetes and cardiovascular disease were identified as community health issues of concern. Extension resources, outcome expectancies of PSE strategies, and networking with community agencies and organizations were the 3 components describing OCEEs' intention to use PSE to address obesity and related chronic disease (Cronbach alpha >0.88). <h3>Conclusion</h3> Findings from this study provide insight to factors related to OCEEs' intent to use PSE approaches and reflect Theory of Planned Behavior constructs. The findings will be used to develop a second survey specific to OCEE to identify if intentions differ between groups of educators and providing context for development of PSE training and technical assistance specific to OCEE addressing public health issues using PSE approaches.

OPREVENT2 Community Action Component to Promote Healthy Policy, Systems, and Environments With Native American Communities: Process Evaluation and Lessons Learned

Abstract Objectives To assess the implementation of the Community Action Component (CAC) of OPREVENT2, which aimed to promote healthy food and physical activity policies, systems, and environments (PSE) with six Native American communities. Methods OPREVENT2 examined the impact of a multi-level, multi-component obesity prevention intervention in six tribal communities in the Southwest and Midwest regions of the US (Three randomly selected to receive the intervention first, three to receive second). The CAC was designed to identify and develop PSE changes in partnership with community partners. We developed the following implementation standards prior to the intervention: we aimed to hold monthly meetings that were ≥1 hour and recruited ≥10 participants representing different stakeholder groups (health staff, store employee, tribal leader, school teachers/staff, and community members). We used measures of frequency to evaluate the extent that we met established reach, dose delivered, and fidelity standards. Results CAC meetings used participatory approaches to discuss ways to use PSE changes to encourage healthy eating and physical activity in stores, schools, worksites, and communities. Overall, we achieved high dose delivered; we held one monthly meeting on average that ranged 60–120 minutes. Reach varied by community; on average we attained 64%, 101%, 479% of the participants. Meetings were attended most often by community members, health staff, and tribal leaders, with low participation from store employees or school teachers/staff. Whenever possible, CAC meetings were planned with existing meetings to enhance reach to encourage sustainability and enable collaboration with community partners. Future interventions could develop a tribal council resolution to encourage other stakeholder groups to attend and promote sustainability of intersectoral work at an earlier stage. Assessing community readiness could assist in developing strategies to promote PSE changes that are tailored to each community. Conclusions The inclusion of CAC complements community-based obesity prevention strategies in Native American communities and can achieve moderate to high reach, dose-delivered, and fidelity. Funding Sources National Heart, Lung, and Blood Institute.

Successful youth advocacy (YA) programs

Disparities in youth obesity continue despite an increasing number of programs designed to combat this challenge. Policy, systems, and environmental (PSE) changes hold promise for these populations. This study identifies lessons from adult leaders for youth advocacy programs. Youth Engagement &amp; Action for Health! (YEAH!) is a youth advocacy curriculum for PSE change that promotes healthy behaviors. From 2017-2019, 18 youth-serving organizations recruited 11-14 year olds from low-income urban, suburban, and rural areas. 237 participants in 19 youth groups completed YEAH! with 28 adult leaders. YEAH! adult leaders completed pre- and post-surveys on adult leader characteristics, group structure and dynamics, barriers to success, and technical assistance needs. Researchers interviewed adult leaders at the completion of each YEAH! project. This community based participatory research (CBPR) project engaged adult leaders to collect data, analyze coded transcripts and interpret results. Clubs evaluated with positive outcomes were facilitated by adult leaders who had previous engagement with the youth, showed enthusiasm for youth advocacy, and had access to resources to motivate group cohesion, participation, and commitment. The adult leader steering committee synthesized the findings into a set of best practices and strategies to help group leaders be as successful as possible when leading future youth advocacy groups.

Policy, Systems, and Environmental Change: A Planning Tool for Community Health Implementation

Extension educators across the United States are being asked to expand their direct education efforts to include policy, systems, and environmental (PSE) changes. However, professional development opportunities and tools are needed to familiarize Extension professionals with PSE change approaches, build their capacity to implement PSE change, and make the process relevant to their work. We describe a planning tool developed for a unique multistate PSE change intervention training and designed to facilitate the process of PSE change implementation at the local level. An example of the tool and recommendations for others wishing to use it are included.

Two States, One Mission: Building Policy, Systems, and Environmental Change Capacity of County Extension Educators

Policy, systems, and environmental (PSE) change interventions are a key part of comprehensive nutrition and health education. Although Extension educators find value in PSE approaches and report being involved in PSE work, many still indicate a lack of understanding regarding PSE approaches. We describe a unique multistate training designed to increase Extension educators' understanding, skills, and capacity related to implementing PSE change interventions. Data demonstrating success of the training are presented. Additionally, best practices for others wishing to create similar multistate programs conclude the article.

SNAP-Ed Policy, Systems, and Environmental Interventions and Caregivers’ Dietary Behaviors

ObjectiveTo examine dietary behaviors and diet quality among caregivers of children regarding the number of policy, systems, and environmental (PSE) change interventions implemented in their neighborhoods. MethodsHouseholds with incomes ≤185% of the federal poverty level were randomly sampled throughout California. A validated 24-h dietary recall assessment tool was administered by telephone. The independent variable was the number of Supplemental Nutrition Assistance Program Education PSE change interventions per census tract where the caregivers lived. ResultsMost (69.1%) of the 2,222 caregivers were Latino. Policy, systems, and environmental reach predicted decreased intake of sugar-sweetened beverages (P = 0.022, Cohen d = −0.12) and added sugar (P = 0.014, Cohen d = −0.18), and increased Healthy Eating Index–2015 scores (P = 0.046, Cohen d = 0.18), regardless of race and/or ethnicity, age, or reach of Supplemental Nutrition Assistance Program Education direct education. Conclusions and ImplicationsReplication of these methods and findings, and comparisons of dietary outcomes in association with PSE change interventions with and without direct education activities aimed at the same population under study, are encouraged.

P125 Role of Cooperative Extension in Obesity Prevention Efforts: Program Implementation, Effectiveness, and Implications

ObjectiveTo demonstrate how Cooperative Extension (CE) can successfully implement federally-funded obesity prevention programs across limited-resource populations and settings.Use of Theory or ResearchSupplemental Nutrition Assistance Program - Education (SNAP-Ed) evaluation framework was utilized spanning multiple levels of the Social-Ecological Model (SEM).Target AudiencePreschoolers, youth, and adults.Program DescriptionDuring 2019, 2 federally-funded nutrition education programs namely CalFresh Healthy Living, University of California (CFHL, UC) and Expanded Food & Nutrition Education Program (EFNEP) were implemented in preschool, schools, and community settings in 2 counties through CE.Evaluation MethodsAge-appropriate observational tools and surveys were used to assess participants’ goals, intentions and behaviors about healthy eating, physical activity, and food resource management. Policy, systems, and environmental (PSE) changes including community partnerships were also recorded.ResultsCFHL, UC evaluation results indicated behavioral and organizational changes through direct nutrition education (n = 10,761 children and youth, and 822 adults reached) and indirect nutrition education (n = 31, 421) across 74 locations of various settings from preschools, schools, to community. PSE changes were recorded at 42 sites reaching 21,087 participants with 59 PSE changes across all settings (eg, 41 nutrition changes, 15 PA changes, and 3 nutrition/PA changes combined). EFNEP evaluation results indicated behavioral changes in nutrition, food resource management, and PA practices among adult participants (n = 187) who completed the program.Conclusions and ImplicationsCE plays a critical role in obesity prevention efforts by implementing federally-funded nutrition education programs in local communities to empower children, youth, and families with knowledge and skills to make healthy living choices. The CE System with offices in most counties across the state brings together expertise and capacity to promote healthy living among qualified settings and the SNAP-Ed eligible population. Taken together, CE is a good fit for obesity prevention programming to achieve a broader impact that has public value significance. To demonstrate how Cooperative Extension (CE) can successfully implement federally-funded obesity prevention programs across limited-resource populations and settings. Supplemental Nutrition Assistance Program - Education (SNAP-Ed) evaluation framework was utilized spanning multiple levels of the Social-Ecological Model (SEM). Preschoolers, youth, and adults. During 2019, 2 federally-funded nutrition education programs namely CalFresh Healthy Living, University of California (CFHL, UC) and Expanded Food & Nutrition Education Program (EFNEP) were implemented in preschool, schools, and community settings in 2 counties through CE. Age-appropriate observational tools and surveys were used to assess participants’ goals, intentions and behaviors about healthy eating, physical activity, and food resource management. Policy, systems, and environmental (PSE) changes including community partnerships were also recorded. CFHL, UC evaluation results indicated behavioral and organizational changes through direct nutrition education (n = 10,761 children and youth, and 822 adults reached) and indirect nutrition education (n = 31, 421) across 74 locations of various settings from preschools, schools, to community. PSE changes were recorded at 42 sites reaching 21,087 participants with 59 PSE changes across all settings (eg, 41 nutrition changes, 15 PA changes, and 3 nutrition/PA changes combined). EFNEP evaluation results indicated behavioral changes in nutrition, food resource management, and PA practices among adult participants (n = 187) who completed the program. CE plays a critical role in obesity prevention efforts by implementing federally-funded nutrition education programs in local communities to empower children, youth, and families with knowledge and skills to make healthy living choices. The CE System with offices in most counties across the state brings together expertise and capacity to promote healthy living among qualified settings and the SNAP-Ed eligible population. Taken together, CE is a good fit for obesity prevention programming to achieve a broader impact that has public value significance.

P146 California Youth Participatory Action Research Projects Illustrates the Need for Nutrition Staff Professional Development

<h3>Background</h3> Youth Participatory Action Research (YPAR) is an innovative approach to engage youth (ages 12-18) in projects that address issues in their community. When implemented as part of a Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program, YPAR aims to empower youth to achieve policy, systems, and environmental (PSE) changes related to community health and nutrition. SNAP-Ed programming has traditionally focused on direct nutrition education, which may require substantially different professional skills than needed to implement YPAR projects. <h3>Objective</h3> This qualitative research project aimed to assess the impact of professional development and learning to support the shift from traditional nutrition education delivery to an approach that engages youth in creating PSE changes. <h3>Study Design, Setting, Participants</h3> Pre- and post-project interviews were conducted with 6 SNAP-Ed staff members who implemented or attempted to implement YPAR projects in 4 California counties during the 2018-2019 school year. Questions assessed the impact of current technical assistance, professional learning opportunities and needs, and suggestions for improving future support. <h3>Analysis</h3> Members of the research team each individually analyzed a subset of the interview responses and reported emerging themes. The team consolidated reports and identified key findings for 3 outcome measures related to 1) Staff capacities for YPAR work aimed at PSE changes; 2) key topics; and 3) key processes/structures for additional professional learning support. <h3>Results</h3> The following themes emerged related to the outcome measures: 1) the importance of comprehensive knowledge and skills related to youth engagement and positive relationship skills to build support for YPAR: 2) the need for information on the history of YPAR; training around PSE change work, evaluation and reporting; and curricula for younger youth; and 3) the need for regular support from supervisors. <h3>Conclusions</h3> Staff articulated the capacities they gained, key learning topics and support received, and additional professional development support needed to conduct a YPAR project. Key themes were identified that can help inform practitioners interested in conducting YPAR projects, especially under the SNAP-Ed framework. <h3>Funding</h3> Supplemental Nutrition Assistance Program - Education.

P45 Identifying Barriers and Facilitators to Implementing Policy, Systems, and Environmental Change Work in Cooperative Extension Using the Consolidated Framework for Implementation Research

<h3>Background</h3> Following guidance provided in the 2014 National Framework for Health and Wellness, Cooperative Extension (CE) nutrition education programs in Louisiana shifted towards making policy, systems, and environmental (<i>P</i>SE) changes to promote healthy eating and increased physical activity according to the social-ecological model of behavior change. The transition to PSE work from an exclusive focus on direct nutrition education posed challenges for CE staff in Louisiana. In order to better understand barriers and facilitators to implementing PSE change work, we conducted qualitative semi-structured interviews with CE staff using constructs from the Consolidated Framework for Implementation Research (CFIR). <h3>Objective</h3> To identify CE staff's perceived barriers and facilitators to implementing PSE change interventions according to CFIR constructs. <h3>Study Design, Setting, Participants</h3> Qualitative semi-structured interviews were conducted with 5 Cooperative Extension staff using an interview guide with questions based on constructs from the Consolidated Framework for Implementation Research (CFIR). <h3>Measurable Outcome/Analysis</h3> Interviews were transcribed verbatim. Transcripts were independently coded by 2 researchers using codes defined a prori according to CFIR constructs. Coding differences were resolved through consensus. <h3>Results</h3> Though all 39 CFIR constructs were relevant, 16 emerged through interviews with CE agents as either barriers or facilitators to the implementation of PSE change work. The adaptability of PSE work and its relative advantage over traditional direct education emerged as major facilitators to its implementation. Major barriers to the implementation of PSE change work included the relative priority of PSE change work within CE agents' organizations, the complexity of PSE change work, and a lack of resources to support implementation. <h3>Conclusions</h3> Implementing PSE change work poses a challenge for CE staff who have traditionally conducted only direct nutrition education programs. Cooperative Extension programs should ensure PSE change work is presented as a priority to all staff within the organization. Training materials for PSE change work should prepare CE staff for the complexity of these interventions and emphasize their advantages over direct education.

O1 Using Comprehensive Approach to Implement Plan Shop Safe Cook Curriculum in a Low-income Hispanic Community

Objective To implement and evaluate a comprehensive approach to adult nutrition education program in a Hispanic low-income community. Use of Theory or Research Based on Social Ecological Model, nutrition education intervention is more effective when it not only focuses on individual level but also levels of interpersonal, organizational, and environmental. Plan Shop Safe Cook (PSSC) is a nutrition family and consumer science curriculum that showed evidence of increased knowledge, skills, and intention to change. Our comprehensive approach will enhance the healthy behavior change by collaborating with the administer of low-income housing authorities to make policy, system, and environment (PSE) change for participants. Target Audience CalFresh Healthy Living Program (CHLP) adult participants who are living in low-income housing authorities in a Hispanic dominated community. Program Description CHLP educators teach a 4-lesson series on meal planning, reading labels, shopping, and cooking annually at the sites. In 2018, our team collaborated with sites managers to make a PSE change by allowing us to build community gardens, give outs seeds and soil, and support container gardens outside their apartments. In Year 2019 PSSC lessons, educators adapted recipes to include vegetables that harvested in their gardens in the cooking lesson and did taste testing. Evaluation Methods Participants complete a pre- and post-test at the beginning and end of the series. The pre/post evaluation tool included 6 resource management items and 1 food security question using a 5-option Likert-type response and 1 open-end question on behavior change they have made after classes. Results Eighty-two percent of participants (n = 124, 88% female, 95% Latino, 33% age 60 years or older) increased at least 1 resource management behaviors and 44% reported greater food security. Three self-reported behavior change themes were merged: freezing their extra produce; adding more vegetables to their diets; and eating less salt and less sugar. Conclusions Building community gardens as PSE change strategy is an effective way to enhance nutrition education towards behavior change in low-income housing authorities. Funding Supplemental Nutrition Assistance Program - Education.

The Louisiana Healthy Communities Initiative: A Community-Participatory Model for Obesity Prevention

Abstract Objectives Louisiana ranks 4th among US states for adult obesity, and 5th highest for physical inactivity. The Healthy Communities Initiative is a novel effort led by Cooperative Extension (CE) and SNAP-Ed staff in Louisiana to change the policy, systems, and environment (PSE) in target communities to encourage increased physical activity and healthier eating behaviors. The objective of this qualitative study was to identify community members’ perceived impacts of the Healthy Communities Initiative on their community according to the Community Capitals Framework using ripple effect mapping. Methods Local CE staff hold community forums where residents identify and prioritize strategies for PSE changes, then recruit community coalition members to collectively address needs identified at the forum. PSE strategies are different for each community targeted, with short-term impacts most effectively evaluated using qualitative methods. Ripple effect mapping is a community participatory qualitative evaluation method which allows evaluators to capture the effects of innovative interventions. Evaluators facilitate a focus group session in which community members create a map of the multiple impacts of an intervention according to the constructs of the Community Capitals Framework. We held a ripple effect mapping session with 15 participants in one Healthy Communities coalition to evaluate their progress after one year of PSE change work. Results Community members identified program impacts in each of the constructs of the community capitals framework. Participants most often identified program impacts that were improvements to the community's political capital, such as an improved ability to advocate for change. Participants identified the most impactful outcomes of the program, which included an increased awareness of inequity in the community, increased access to fresh produce for community members, and making connections with agencies and organizations which stretched across organizations’ “silos.” Conclusions The Louisiana Healthy Communities Initiative is an innovative strategy to encourage the adoption of PSE changes for obesity prevention. Ripple effect mapping proved to be an effective method for assessing community members’ perceptions of program impacts. Funding Sources SNAP-Ed.

Creating healthier policies, systems, and environments: Using the CDC CHANGE tool to evaluate the impact of a coalition provided community-based wellness program.

This manuscript describes policy, systems, and environments (PSE) changes made to support health secondary to a county-based coalition nurse-led program targeting vulnerable populations at five community-based sites in a single rural Midwest county. A mixed-methods pre-post approach was used to evaluate the PSE changes occurring over a 1-year period secondary to wellness programming. Five community sites including three predominantly manufacturing worksites and two faith-based sites were included in this study. The Centers for Disease Control and Prevention Community Health Assessment aNd Group Evaluation tool was used to collect PSE data both at site initiation and 1year later. Logs kept by program staff which included discussions with site leaders and program participants were also used to measure PSE changes. Monthly wellness programming which included intentional feedback to site leadership concerning participant feedback and coalition staff observations of the impact of site specific PSEs on healthy lifestyle behaviors. Positive changes reflecting improvement in policy and environments were noted for 99.2% of the scores with a total of 13 PSE changes documented across the sites. The greatest change noted related to leadership, indicating increased commitment by site leadership to support health.

Implementation of policy, system and environment changes in early childhood education settings

BackgroundChanging Policy, System, and Environmental features focused on physical activity and healthy eating behaviors can play a key role in obesity prevention strategies in early childhood education settings because of their broad reach and because they can be sustained over time. The primary aims of this study were to examine the implementation and sustainability of health-promoting PSE changes after facilitation of an innovative strategic planning process in child care settings.MethodsThe evidence-based policy, system, and environment change process is a strategic planning tool derived from intervention mapping that involves convening interdisciplinary wellness teams at child care settings to implement healthy eating and physical activity-related policy changes. The process was conducted with 43 wellness teams representing 68 child care centers.ResultsThe average number of health-promoting evidence-based changes implemented across all child care centers was 5.07; the most common type of changes were environment changes. Overall, 42% of changes were partially implemented and 47% of changes were fully implemented at 6 months. Head Start wellness teams implemented 1.52 fewer health-promoting changes compared to private fee-based wellness teams (p < .05).ConclusionsIdentifying health-promoting policy, system and environment changes that are most readily implemented and sustained in child care centers can inform systems-level interventions and resource allocation related to early childhood obesity. This strategic planning process is a successful tool to translate sustainable changes related to healthy eating and physical activity, improve the quality rating of diverse child care centers, and promote healthy behaviors in early childhood.

Safety and Health Innovation in Preschools: A Total Worker Health Pilot Project.

The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers. An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact. Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes. This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.

Evaluation of a Policy, Systems, and Environmental-Focused Faith-Based Health Promotion Program

This study assessed the impact and lessons learned from implementing policy, systems, and environmental (PSE) changes through Faithful Families Thriving Communities (Faithful Families), a faith-based health promotion program, in 3 southern states. Faithful Families classes and PSE changes were implemented through a coordinated effort between the Expanded Food and Nutrition Education Program (EFNEP) and Supplemental Nutrition Assistance Program-Education (SNAP-Ed). Changes were measured using a faith community assessment, site reports, and annual reporting. Thirteen faith communities participated in the intervention. A total of 34 PSE changes were implemented across the 3 states, affecting 11 faith communities with 4,810 members across sites. Programs such as Faithful Families can allow EFNEP and SNAP-Ed to coordinate to implement PSE changes in community settings. However, these types of coordinated programs to support faith communities require time for relationship building and trust, adequate training, and strong support for faith-based lay leaders as they carry out this work.

Supporting Healthy Eating: Synergistic Effects of Nutrition Education Paired with Policy, Systems, and Environmental Changes.

A healthy diet is central to health and well-being throughout life. The United States and many other countries are undergoing an obesity epidemic and experiencing serious diet-related health problems. There exists a misalignment and wide gap between national dietary recommendations and dietary patterns of Americans, and thus, a need to find new ways to improve diet and nutrition. This article posits that nutrition education combined with policy, systems, and environmental (PSE) change approaches is more effective than either strategy in isolation and both are needed to reduce the global burden of diet-related chronic diseases. This article presents a conceptual framework for understanding the multiple influences on what people eat; discusses the need for PSE strategies to augment direct nutrition education approaches; and highlights examples of synergistic and promising linkages between nutrition education and PSE strategies in 3 areas: federal nutrition assistance programs, food retail settings, and nutrition and calorie labeling. In addition, future directions where this synergistic approach holds promise for improving population health and reducing health inequities are discussed. Nutrition education combined with PSE changes at governmental and community levels, as well as strategic public-private alliances have the potential to change the way people eat and improve health and well-being.

Use of Decision Cases for Building SNAP-Ed Implementers’ Capacities to Realize Policy, Systems, and Environmental Strategies

ObjectiveTo develop and validate decision cases as a capacity-building training tool for implementing policy, systems, and environmental (PSE) change strategies. DesignStudy phases were: (1) in-depth interviews conducted repeatedly over a year with Supplemental Nutrition Assistance Program Education (SNAP-Ed) partner sites and once with SNAP-Ed implementers to identify dilemmas when implementing PSE change strategies; (2) decision cases developed to highlight dilemmas; and (3) focus groups with SNAP-Ed implementers to determine decision case utility as a capacity-building training tool. SettingA southeastern state. ParticipantsSNAP-Ed partner sites and implementers; Focus group participants. InterventionDecision cases. AnalysisTo establish content validity, a thematic analysis of interviews identified common dilemmas when implementing PSE change strategies. SNAP-Ed implementers’ focus groups provided feedback to determine the utility and validity of decision cases developed from the analysis. ResultsCommon dilemmas of implementation of PSE change strategies reported by SNAP-Ed partner sites (n = 20) and implementers (n = 8) were lack of site and educator readiness and capacity; communication breakdowns; and prioritization of nutrition education over PSE implementation. Focus group participants (n = 8) reviewed a case and discussion guide and recommended them as a capacity-building tool for training. Conclusions and ImplicationsUsing decision cases could help build SNAP-Ed implementers’ capacities to implement nutrition PSE change strategies and strengthen partnerships.

Toward Sexual Health Equity for Gay, Bisexual, and Transgender Youth: An Intergenerational, Collaborative, Multisector Partnerships Approach to Structural Change.

Background. Gay, bisexual, and transgender youth (GBTY) experience sexual health inequities and contend with intersectional oppression. The Michigan Forward in Enhancing Research and Community Equity (MFierce) Coalition formed as an intergenerational, collaborative, multisector partnership with a focus on implementing community-identified policy, systems, and environmental (PSE) change strategies to address inequities and injustices. Aims. We describe MFierce coalition development and structural change activities organized within Collaborating for Equity and Justice (CEJ) principles and provide empirical data supporting the utility of such principles. Method. We prioritized leadership by GBTY and created personal and professional capacity-building activities to support GBTY in being change agents. Our work was grounded in community-engaged scholarship and used a shared-power community development process. Our PSE change intervention, the Health Access Initiative (HAI), was a structural change program for health facilities aimed at improving the quality of and access to sexual health care for GBTY. Results. We evaluated coalition functioning and activities through multimethod assessments and evaluated PSE changes through HAI participant surveys. Data demonstrated positive and steady coalition dynamics, multiple benefits of participation for GBTY, and strategies for collaborative multigenerational community work. HAI outcome data revealed significant increases in PSE changes. Discussion. Centering life experiences of GBTY in collaborative partnerships and building opportunities for professional and personal development can support sustainable community change. We offer recommendations for developing future intergenerational, collaborative, multisector partnerships that prioritize youth leadership. Conclusion. Collaborative methods and careful consideration of adult-youth dynamics can inform future transformative efforts focused on health equity and justice for GBTY.