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Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
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3
Perspectives of Site Leaders

During the discussion in this session, several themes emerged with respect to how better decision making and improved evaluations can be achieved:

  • Improve coordination and communication among the various stakeholders involved in the implementation and evaluation of obesity prevention programs.

  • Lengthen evaluation periods so that positive change can be demonstrated.

  • Enhance evaluation methods to capture progress toward program goals as well as long-term outcomes.

  • Develop local data that are helpful in setting baselines for measurement of the success of obesity prevention efforts, and an accessible database to track community-based obesity prevention initiatives and their effectiveness.

IMPROVE COORDINATION AND COMMUNICATION AMONG THE VARIOUS STAKEHOLDERS

Site leaders described what it is like to work in individual communities. They are relied upon as the contact point for various stakeholders, including funders, evaluators, and policy experts. A number of site leaders believe this creates an overreliance on one individual without an adequate infrastructure or additional staff to support the types of programs that are needed. One of the concerns raised was the lack of a clearinghouse func-

Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
×

tion that would allow communication among the various stakeholders and reduce this reliance on a single community site leader. Often policy experts, funders, evaluators, and site leaders fail to communicate with one another. As a result, information is not available to those who need it, and goals are set and strategies implemented without the input of important stakeholders. A number of site leaders suggested that regular forums involving all stakeholders would be helpful in addressing this concern.

LENGTHEN EVALUATION PERIODS

Site leaders acknowledged the important role of evaluation in childhood obesity prevention programs. However, a number of them also expressed frustration with evaluation on several fronts. Sustainable, multifaceted changes to the community environment take time, especially given the nature of working with local city planners, councils, and neighborhoods, among other stakeholders. The initiation of projects and the achievement of progress often require agreement and action by multiple parties at the community level. Yet evaluations are commonly conducted in a short time frame.

ENHANCE EVALUATION METHODS TO CAPTURE PROGRESS AS WELL AS LONG-TERM OUTCOMES

Several site leaders suggested the need to develop evaluation methods that can capture a community’s interim gains toward childhood obesity prevention instead of just ultimate outcomes. They described working in low-income communities where a significant proportion of children are struggling with being overweight or obese, and where the local environment poses several obstacles to children’s engaging in healthful eating and physical activity. In such a context, an exclusive focus on measuring outcomes could be problematic. For example, as discussed earlier, a community’s obesity rate may be so high that it is infeasible to achieve measurable positive changes in a relatively short time frame. Several site leaders emphasized that progress in environmental change is difficult to achieve but is a necessary step in obesity prevention. Typical evaluations fall short in capturing this important point. As one site leader suggested, the key is determining how to measure change, not necessarily an end point; evaluations of childhood obesity prevention programs are always, in a sense, process evaluations because communities are never going to complete the improvements they are seeking to effect. Site leaders proposed that discussion and development of progress measures for childhood obesity prevention programs would be a positive step and that they could be helpful if called upon to contribute to such efforts.

Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
×

DEVELOP LOCAL DATA AND AN ACCESSIBLE DATABASE

A number of site leaders reported that, to work effectively within a community, they need readily available local data on various aspects of the community. The availability of community-based data that have already been collected would allow them to spend more time designing and implementing interventions and less time collecting preliminary information.

During the discussion of local data needs, two major issues emerged. First, local data about the built environment, population characteristics, and other factors would facilitate tailoring work to the community’s needs and benchmarking progress. Yet several participants cited a lack of access to such data; rather, data often are available only at the state or national level.

A second data issue is a lack of access to information on obesity prevention programs and successes within the site leaders’ own or other communities. Several participants were unaware of how to access past evaluations or other data previously collected, or even how they would know that such data had been collected in their own or similar communities. Although they know the data are being collected, they do not know where and how the data can be accessed.

One way to address this issue would be to institute a web-based forum or database that would report details of initiatives, studies, measures used, and evaluation results. Such a web-based resource could document past and current studies and evaluations and be easily searchable by community, town, district, or county. Having this resource would render more useful the large amount of data being collected and save valuable time that could then be devoted to program development and implementation.

Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
×

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Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
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Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
×
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Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
×
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Suggested Citation:"3 Perspectives of Site Leaders." Institute of Medicine. 2009. Community Perspectives on Obesity Prevention in Children: Workshop Summaries. Washington, DC: The National Academies Press. doi: 10.17226/12705.
×
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As the public health threat of childhood obesity has become clear, the issue has become the focus of local, state, and national initiatives. Many of these efforts are centered on the community environment in recognition of the role of environmental factors in individual behaviors related to food and physical activity. In many communities, for example, fresh produce is not available or affordable, streets and parks are not amenable to exercise, and policies and economic choices make fast food cheaper and more convenient than healthier alternatives.

Community efforts to combat obesity vary in scope and scale; overall, however, they remain fragmented, and little is known about their effectiveness. At the local level, communities are struggling to determine which obesity prevention programs to initiate and how to evaluate their impact.

In this context, the Institute of Medicine held two workshops to inform current work on obesity prevention in children through input from individuals who are actively engaged in community- and policy-based obesity prevention programs. Community perspectives were elicited on the challenges involved in undertaking policy and programmatic interventions aimed at preventing childhood obesity, and on approaches to program implementation and evaluation that have shown promise. Highlights of the workshop presentations and discussions are presented in this volume.

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