Assessing Implementation Fidelity in a Community Health Improvement Plan

This paper describes and analyzes a pre-post non-experimental process evaluation in a Community Health Improvement Plan and the building of evidence for program improvement in the Plan, Do, Check and Act (PDCA) continuous improvement cycle with a focus on the Check and Act steps. The findings will help stakeholders to gain insight into plan implementation and consider necessary design and process adjustments. An overall mean completion rate of 60.44% was recorded with achievement scores ranging from 0% (goals 4 and 5) to 87.92% (goal 1). At the mid-point of implementation, completion for each priority issue was as follows: completion and fidelity rates for action steps addressing healthy behaviors priority issue was 78.05%, the implementation rate for action steps addressing Health Care Capacity, Access, and Delivery priority issue was 43.38%; and the completion rate for action steps addressing changes in policy systems, environment priority issue was at 50%. The level of implementation completion for each priority issue and corresponding action steps aligns with the degree of issue complexity predicted in the conceptual framework. These patterns suggest that initiatives that addressed fundamental causes of poor health status are harder to implement as evidenced by lower completion and fidelity rates.

Healthy Eating and Physical Activity Policy, Systems, and Environmental Strategies: A Content Analysis of Community Health Improvement Plans

Background: Policy, systems, and environmental (PSE) approaches can sustainably improve healthy eating (HE) and physical activity (PA) but are challenging to implement. Community health improvement plans (CHIPs) represent a strategic opportunity to advance PSEs but have not been adequately researched. The objective of this study was to describe types of HE and PA strategies included in CHIPs and assess strategies designed to facilitate successful PSE-change using an established framework that identifies six key activities to catalyze change.Methods: A content analysis was conducted of 75 CHIP documents containing HE and/or PA PSE strategies, which represented communities that were identified from responses to a national probability sample of US local health departments (<500,000 residents). Each HE/PA PSE strategy was assessed for alignment with six key activities that facilitate PSE-change (identifying and framing the problem, engaging and educating key people, identifying PSE solutions, utilizing available evidence, assessing social and political environment, and building support and political will). Multilevel latent class analyses were conducted to identify classes of CHIPs based on HE/PA PSE strategy alignment with key activities. Analyses were conducted separately for CHIPs containing HE and PA PSE strategies.Results: Two classes of CHIPs with PSE strategies emerged from the HE (n = 40 CHIPs) and PA (n = 43 CHIPs) multilevel latent class analyses. More CHIPs were grouped in Class A (HE: 75%; PA: 79%), which were characterized by PSE strategies that simply identified a PSE solution. Fewer CHIPs were grouped in Class B (HE: 25%; PA: 21%), and these mostly included PSE strategies that comprehensively addressed multiple key activities for PSE-change.Conclusions: Few CHIPs containing PSE strategies addressed multiple key activities for PSE-change. Efforts to enhance collaborations with important decision-makers and community capacity to engage in a range of key activities are warranted.

Assessing Policy Advocacy Choice and Strategy in a Community Health Improvement Plan

SWOT analysis and an eight-item best practice assessment instrument, are utilized to asses intergovernmental public health policy development to advance tobacco free living in a Mid-Western region of the United States. Findings revealed similar patterns across methods and data sources. Compared to effective and tested practices, the tobacco free policy advocacy strategy was successful at both the statewide level and regional level. Agendas were more aligned among community partners for regional initiatives than for statewide initiatives. Also, it was clear that alignment of agendas at the community partnership level was harder when issues were tough and opposition from economic interest was high.