Evaluating Obesity Prevention Efforts A Plan for Measuring Progress (2013) / Chapter Skim
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8 Monitoring and Summative Evaluation of Community Interventions
8 Monitoring and Summative Evaluation of Community Interventions
Pages 223-254
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A template for customizing plans for monitoring and summative evaluation identifies priorities to accommodate local differences in terms of opportunities for change, context, resources avail able for evaluating strategies recommended in the Accelerating Progress in Obesity Prevention report, and stakeholder input. Because innovations in obesity prevention often receive their initial test at the community level, rigorous and practical methods are desirable to build national knowledge.
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224 Evaluating Obesity Prevention Efforts
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. Several strategies with evidence of effectiveness are listed in the Centers for Disease Control 4 Although random assignment of communities to entire policies and systems has not, to the Committee's knowledge, been attempted in the obesity prevention field, both the United States and other countries have randomly assigned place and people to policies in the past, as in the case of the RAND Health Insurance Experiment (Brook et al., 2006)
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5 Commissioned for the Committee by Allen Cheadle, Ph.D., Group Health Cooperative; Suzanne Rauzon, M.P.H., University of California, Berkeley; Carol Cahill, M.L.S., Group Health Cooperative; Diana Charbonneau, M.I.T., Group Health Cooperative; Elena Kuo, Ph.D., Group Health Cooperative; Lisa Schafer, M.P.H., Group Health Cooperative. 226 Evaluating Obesity Prevention Efforts
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As seen below, some relatively simple additions to design and measurement can greatly improve the monitoring and summative evaluation plan, thus adding to national knowledge about community interventions. Tailoring the Plan to the Intervention Context and Logic In community-level interventions, the number and kind of strategies are highly diverse and may vary substantially from one initiative to another, as communities implement programs, policies, and environmental changes that address their specific issues and context.
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The core of any plan includes engaging stakeholders, identifying resources, having a logic model or theory of change, selecting the right focus, using appropriate measures, collecting quality data, using appropriate analytic methods, interpreting or making sense of the data, and disseminating the findings. BOX 8-1 Components of a Community-Level Obesity Intervention Monitoring and Summative Evaluation Plan Purpose: To guide community action and to inform national choices about the most effective and cost- effective strategies identified in the Accelerating Progress in Obesity Prevention report for funding, dis semination, and uptake by other communities.
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Certain issues, however, are central to developing an effective local evaluation of obesity prevention. For this reason, the chapter devotes a good bit of attention to stakeholder involvement, emerging methods, and interpretation of findings.
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. Participatory approaches to community monitoring and summative evaluation reflect a continuum of community engagement and control -- from deciding the logic model and evaluation questions to making sense of the data and using them to improve obesity prevention efforts.
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. Culturally competent evaluation can assess whether interventions focus on issues of importance to the cultural group; whether interventions address where and how people eat, shop, and spend recreational time; and which environmental changes produce the most powerful enablers for more healthful nutrition and physical activity.
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Activities and outputs are logically connected to short-, intermediate-, and long-term outcomes: for example, engagement of local decision makers is presumed to help to achieve Initial Policy, Environment, Change Conditions System Changes Diet Reduce Obesity Prevalence Change Inputs Community Physical Programs Engagement Activity FIGURE 8-1 Generic logic model or theory of change for community obesity prevention. NOTES: Not all interventions will include programs, policies, and environmental changes or systems changes.
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changes in policy and environment, which are presumed to change diet or physical activity and, therefore, help to achieve healthy weight for a greater portion of the population. Logic models and theories of change help greatly to assess the plausibility that particular interventions can achieve their goals.
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. 234 Evaluating Obesity Prevention Efforts
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One approach is to invest more resources in evaluation of a specific component of a multi-strategy initiative, rather than trying to evaluate all of them. The choice depends on the logic model, because it allows the plan to consider components that are • ready for evaluation; • more likely to have an impact in the time frame of the evaluation; • plausible to achieve sufficient "dose" to change behavior, environments, or health outcomes; Monitoring and Summative Evaluation of Community Interventions 235
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Resource • Ongoing funding versus one-time funding to support the staffing required to develop and maintain availability and the system over time constraints -- -- Data systems/programmer support -- -- Policy analyst support -- -- Evaluation research support SOURCE: Information summarized from Chriqui et al., 2011. 236 Evaluating Obesity Prevention Efforts
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. Monitoring and Summative Evaluation of Community Interventions 237
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. Unfortunately, small population-level changes are difficult 238 Evaluating Obesity Prevention Efforts
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Many designs can help to reduce uncertainty about which interventions are most promising or powerful for obesity prevention for subsequent more-definitive evaluations. With a few simple additions, weaker designs can become substantially stronger for assessing effectiveness as the program investment rises.
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Thus, if a behavioral outcome improves but there are no corresponding community changes, or if the intervention does not have a sufficient dose (i.e., strength of intervention, duration, and reach) , then it is 240 Evaluating Obesity Prevention Efforts
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. Causal modeling, also called path analysis, builds on the logic model approach by establishing that an intervention precedes the outcomes in time, then applies regression analysis to examine the extent to which the variance in outcomes is accounted for by the intervention compared to other forces.
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If these improvements were made, then strategies could be compared for their effectiveness and cost-effectiveness. With more systematic attention to measuring costs and out comes in a commonly accepted fashion, obesity prevention could achieve the same ability to translate interventions to the bottom line for health, cost-effectiveness, and quality of life that the health sector has 242 Evaluating Obesity Prevention Efforts
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Shared Interpretation of Results and Cultural Competence The Committee acknowledges that each community is unique in its aims, context, and broader determinants of health. Yet, across communities, when local people, such as those experiencing health disparities consistently point to preferences for particular obesity prevention strategies, when they "vote with their feet" for participation and engagement, or when they consistently interpret community conditions such as built environment features in particular ways, then it behooves evaluators to listen.
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The TWOTN video and collateral 244 Evaluating Obesity Prevention Efforts
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Regardless of research design, the Committee would emphasize the importance of • utilizing strong theoretical or logic models (Cheadle et al., 2003; Julian, 1997) ; • monitoring reach or dosage, which is actually a critical step in the logic model for any health promotion program or mass media campaign (Cheadle et al., 2012; Glasgow et al., 2006; Hornik, 2002)
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to support the successful implementation of the components of the Community-Level Obesity Intervention Monitoring and Summative Evaluation Plan. 246 Evaluating Obesity Prevention Efforts
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American Journal of Preventive Medicine 37(4)
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. 248 Evaluating Obesity Prevention Efforts
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American Journal of Preventive Medicine 27(2)
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:251-257. 250 Evaluating Obesity Prevention Efforts
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A systematic review. American Journal of Preventive Medicine 22(4 Suppl)
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:561-589. 252 Evaluating Obesity Prevention Efforts
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American Journal of Preventive Medicine 42(5)
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