Assessing local capacity for health intervention

https://doi.org/10.1016/j.evalprogplan.2008.01.001Get rights and content

Abstract

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB™ Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.

Introduction

Minkler and Wallerstein (2002) conclude that a “major limitation of most community-organizing and community building efforts to date has been a failure to adequately address evaluation processes and outcomes” (p. 295). However, the problem of there being a dearth of formal evaluation initiatives and methods is changing. Participatory evaluation can indeed improve both the process and outcome of health education and promotion initiatives. For instance, in their examination of a community-based participatory research initiative, Bryant et al. (2007) found that whereas rigorous and sophisticated evaluation designs had obvious strengths, those presumed benefits had to be balanced against what community members perceived as unnecessary complexity. Community members preferred easy-to-understand, straightforward, and practical measures that could offer rapid feedback and facilitate their seeking funds to sustain interventions through local foundations and philanthropic organizations. Community members also offered an alternative lens for evaluating health education intervention results, thereby expanding the scope for evaluation, minimizing the “clinical trials” mindset that often resides with academic researchers, increasing the local relevance of some results versus others—thereby offering guidance for program re-design or providing focus for the next intervention, and diminishing the boundaries that separate “insiders” from “outsiders.” Finally, by allowing community members to make context relevant to the evaluation, academicians can gain insights for framing interventions and improving understanding of what Green (2006) refers to as “practice-based evidence” (p. 406).

Participatory, community-based public health coalitions play an important role in fostering improvement in public health outcomes (Pluye, Potvin, & Denis, 2004; Pluye, Potvin, Denis, & Pelletier, 2004). To serve in this role, coalitions must have both the generic “capacity for action needed to address any health problem” and community capacity required to facilitate the prevention process (Chinman et al., 2005, p. 146). Brownson, Kreuter, Arrington, and True (2006) refer to capacity as an intermediate outcome; capacity comes between the intervention and the long-term health outcome (see also Chinman et al., 2005).

Many definitions of capacity have been offered. According to The American Heritage® Dictionary of the English Language, Fourth Edition (2000), capacity refers to “the ability to receive, hold, or absorb” (http://www.bartleby.com). Capacity occurs at multiple levels—community, organizational, and individual (Chinman et al., 2005). This paper focuses at the community and organizational levels. Whereas community and organizational capacity are distinct entities, they are related. Chinman et al. provide a review of the community capacity literature, including definitions. Community capacity definitions emphasize skills (e.g., ability to garner resources) necessary to affect change (Chinman et al.). Four core dimensions of community capacity have been identified (Chinman et al.), including community (e.g., member involvement), skills (e.g., problem solving), resources (e.g., people power), and power (i.e., collective efficacy). In contrast, organizational capacity refers to the “adequacy of inputs (knowledge, financial resources, trained personnel, well-managed strategic partnerships, etc.) necessary to carry out a program and achieve desired outcomes” (Cassidy & Leviton, 2006, p. 149). These resources may include inputs needed to sustain as well as implement a program (Chinman, Imm, & Wandersman, 2004).

Sustainability, in addition to capacity, should be considered as a process beginning with program planning (Johnson, Hays, Center, & Daley, 2004; Pluye, Potvin, & Denis, 2004; Pluye, Potvin, Denis, Pelletier, & Mannoni, 2005; Weiss, Coffman, & Bohan-Baker, 2002). From an evaluation perspective, sustainability should also be operationalized as an outcome, and it should be tracked (Pluye, Potvin, Denis et al., 2004; Weiss et al., 2002). Monitoring sustainability outcomes and providing feedback to evaluation stakeholders in a timely manner can increase community or organizational capacity to sustain effective programs (Weiss et al., 2002). Based on Pluye et al's work, a toolkit for specifically assessing sustainability process and outcome is available online (www.cacis.umontreal.ca/perennite/index_en.htm).

Much needs to be learned about the capacity required to implement and sustain local, evidence-based interventions (Chinman et al., 2005). Moreover, applied and innovative evaluation methods that allow for the assessment of such capacity are needed. The purpose of this paper is to describe the assessment methods used to determine the capacity required to implement and sustain a local physical activity intervention program—the VERB™ Summer Scorecard (VSS) program. Capacity evaluation methods are described with emphasis on the theoretical framework used to guide them. Capacity tables are presented as a program planning tool and as a system for sharing implementation and sustainability requirements for potential program adopters (Brownson et al., 2006). Gauging the match between existing local capacity and necessary program capacity requirements is discussed as a data-based approach to disseminating locally derived programs to other communities (Table 1).

Community level interventions that modify the social environment have the potential to influence health-related outcomes such as obesity (Cohen, Finch, Bower, & Sastry, 2006). In response to growing concerns about the increasing prevalence of obesity and the health risks associated with it, a community-wide coalition to address obesity prevention was organized in 2003 in Sarasota County, Florida. The coalition comprised representatives from government agencies (e.g., health department, school board), non-profit organizations, and businesses across the county offering products or services related to obesity prevention. After a year of strategic planning and goal setting, the coalition decided to replicate a community-based intervention developed by a similar group in Lexington, Kentucky (Courtney, Florida Prevention Research Center, & VERB™ Partnership Team, 2006). The program, called VSS, was designed to offer a wide variety of opportunities for tweens (youth ages 9–13 years old) to be physically active in the community. Although VSS is a local, community-based initiative, it capitalized on the national social marketing campaign, VERB™ It's What You Do, implemented by the Centers for Disease Control and Prevention (CDC). VERB™ promotes participation in physical activity by tweens. The philosophy of VERB™ is to encourage tweens to try “new” activities, emphasizing fun and adventure rather than high-level performance or skill. (Additional information on how to start a VSS program is available in Courtney et al. (2006). The scorecard manual is available for download at http://publichealth.usf.edu/prc/downloads.html.)

In Sarasota county, the VSS program was the first project sponsored by the coalition and implemented in 2005 with funding through the Florida Prevention Research Center (FPRC) at the University of South Florida. In addition to funds, the FPRC provided technical assistance in social marketing and program planning and evaluation.

Section snippets

Implementation 2005

The coalition began development of the VSS program in February 2005. Initial steps included recruiting community partners, developing a promotional brochure, and designing the scorecard, with input from Sarasota county tweens and parents. Over 30 partners (vendors) agreed to participate in the VSS program and offer activities such as paintball, golf, roller-skating, skate boarding, swimming, kayaking, and numerous others. Vendors were divided almost equally between those who devoted between one

Capacity assessment

The FPRC spearheaded the VSS program capacity evaluation (year one) in the fall of 2005. The Wilder Collaboration Factors Inventory was administered to coalition members (n=11) during one of the scheduled meetings. In addition, telephone interviews were conducted with members of the coalition executive committee (n=10) and vendors (n=13). FPRC staff analyzed primary and secondary data. A summary report was developed and provided to key stakeholders. In addition, the results of this evaluation

Discussion

This paper presented an example of methods to use in assessing the capacity needed to implement and sustain a community-based intervention. The strengths and weaknesses of the capacity assessment described herein should be considered prior to adoption. For example, strengths include the engagement of community partners in the evaluation process, the use of a theoretical framework to guide data collection and share results with current and future program adopters, the use of mixed methods (i.e.,

Conclusions

Participatory, community-based public health coalitions offer much to learn about the implementation and sustainability of local and evidence-based interventions because of their presence within the realm of practice. The VSS capacity evaluation (year one) has been conducted and the results used for program revision and sustainability planning purposes. The second year capacity evaluation is underway to coincide with the post-2006 VSS program implementation. Year two focuses on program

Acknowledgments

The authors would like to thank the members of the Sarasota County Obesity Prevention Coalition. This publication was supported by Cooperative Agreement Number 1-U48-DP-000062 funded by the Centers for Disease Control and Prevention, Prevention Research Centers Program. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

Moya L. Alfonso is a Research Assistant Professor at the Florida Prevention Research Center and Senior Research Coordinator for the Center for Social Marketing at the University of South Florida (USF) College of Public Health.

References (17)

There are more references available in the full text version of this article.

Cited by (0)

Moya L. Alfonso is a Research Assistant Professor at the Florida Prevention Research Center and Senior Research Coordinator for the Center for Social Marketing at the University of South Florida (USF) College of Public Health.

Jen Nickelson is a doctoral student in the Department of Community and Family Health at the USF College of Public Health and a Graduate Research Associate for the Florida Prevention Research Center at the USF College of Public Health.

David L. Hogeboom is Coordinator of Research Programs and Services for Academic Affairs and for the Florida Prevention Research Center at the USF College of Public Health.

Jennifer French is a Healthy Living Coordinator for the Sarasota County Health Department.

Carol A. Bryant is a Professor in the Department of Community and Family Health and Co-Director of the Florida Prevention Research Center at the USF College of Public Health.

Robert J. McDermott is Professor in the Department of Community and Family Health and Co-Director of the Florida Prevention Research Center at the USF College of Public Health.

Julie A. Baldwin is a Professor in the Department of Community and Family Health and the Co-Director of the Research Methods and Evaluation Unit of the Florida Prevention Research Center at the USF College of Public Health.

View full text