A Methodology for Evaluating Organizational Change in Community-Based Chronic Disease Interventions

Monterey County Health Department, Salinas, California, USA.
Preventing chronic disease (Impact Factor: 2.12). 11/2007; 4(4):A105.
Source: PubMed


In 2003, the Monterey County Health Department, serving Salinas, California, was awarded one of 12 grants from the Steps to a HealthierUS Program to implement a 5-year, multiple-intervention community approach to reduce diabetes, asthma, and obesity. National adult and youth surveys to assess long-term outcomes are required by all Steps sites; however, site-specific surveys to assess intermediate outcomes are not required.
Salinas is a medically underserved community of primarily Mexican American residents with high obesity rates and other poor health outcomes. The health department's Steps program has partnered with traditional organizations such as schools, senior centers, clinics, and faith-based organizations as well as novel organizations such as employers of agricultural workers and owners of taquerias.
The health department and the Stanford Prevention Research Center developed new site-specific, community-focused partner surveys to assess intermediate outcomes to augment the nationally mandated surveys. These site-specific surveys will evaluate changes in organizational practices, policies, or both following the socioecological model, specifically the Spectrum of Prevention.
Our site-specific partner surveys helped to 1) identify promising new partners, select initial partners from neighborhoods with the greatest financial need, and identify potentially successful community approaches; and 2) provide data for evaluating intermediate outcomes matched to national long-term outcomes so that policy and organizational level changes could be assessed. These quantitative surveys also provide important context-specific qualitative data, identifying opportunities for strengthening community partnerships.
Developing site-specific partner surveys in multisite intervention studies can provide important data to guide local program efforts and assess progress toward intermediate outcomes matched to long-term outcomes from nationally mandated surveys.

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    • "In 2003, the Monterey County Health Department in California was one of 12 initial sites selected to receive funding from the Steps Programs cooperative agreement with the Centers for Disease Control and Prevention (CDC). This funding is being used to implement a 5-year, community-based intervention to reduce the burden of diabetes, asthma, and obesity in Salinas (Hanni, Mendoza, Snider, & Winkleby, 2007; MacDonald et al., 2006). "
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    ABSTRACT: As part of a 5-year community-based intervention in Salinas, California, the Steps to a Healthier Salinas team developed a taqueria intervention addressing obesity and diabetes among Mexican Americans. The authors present: (a) a comparison of service/entrée options for Salinas taquerias (n = 35) and fast-food restaurants ( n = 38) at baseline, (b) a case study of one taqueria, (c) a description of a healthy nutrition tool kit tailored to taquerias, and (d) an evaluation of the intervention at Year 3. It was found that traditional Mexican American-style menu offerings at taquerias tended to be healthier than American-style fast-food restaurant offerings. In addition, the initial response to the intervention has shown positive changes, which include the taqueria owners promoting available healthy menu items and modifying other menu offerings to reduce fats and increase fruit and vegetable availability. This, in turn, has led to a transition of the owners' perceptions of themselves as gatekeepers for a healthy community.
    Health Promotion Practice 04/2009; 10(2 Suppl):91S-99S. DOI:10.1177/1524839908331268 · 0.55 Impact Factor
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    Preventing chronic disease 11/2007; 4(4):A85. · 2.12 Impact Factor
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    ABSTRACT: Studies of neighborhood influences on health behaviors suggest that residence in deprived neighborhoods increases the risk of unhealthy behaviors because of less availability and lower quality of health-promoting resources. However, almost all studies have used indirect measures of neighborhood resources when examining these associations. We used direct measures of tobacco, food, and physical activity environments to compare three socioeconomically contrasting neighborhoods and examine whether the lower income neighborhood had fewer health-promoting resources (and of a lower quality) than the higher income neighborhood. The three neighborhoods in Salinas, California, were selected based upon census data and advice from city planners. A complete census of tobacco, food, and outdoor physical activity resources in each neighborhood was carried out in 2004-2005. Data collected included availability, cost, and variety of specific foods; characteristics of resources, including hours, appearance, size, and advertising; tobacco availability and location, promotional materials and enforcement; and appearance and quality of physical activity resources. Data were compared across the neighborhoods. The largest differences by neighborhood income were found in quality rather than availability of resources. Although food in general was less expensive in the lower income neighborhood, it also had lower availability of produce and milk. Similarly, even though there were more parks in the lower income neighborhood, they were smaller and were rated higher on traffic hazards and lower on amenities and aesthetics. We suggest that neighborhood income may not be highly correlated with overall availability of tobacco, food, and/or physical activity resources, as some studies have documented. Rather, correlations may depend more upon qualitative characteristics.
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