In The Community

Community Health Initiatives



Building the Field

The following is a list of publications that describe our efforts and document the impact they are having on community health:

Evaluation Team Sources

Obesity Prevention Approaches/Strategies

An Integrated Framework For The Prevention And Treatment Of Obesity And Its Related Chronic Diseases — Presents a new framework for the prevention and treatment of obesity that sets forth an affirmative role for healthcare organizations in connecting patients to community-based resources for healthy eating and active living as well as in addressing the upstream conditions that drive health. It’s offered up as a new iteration of the Chronic Care Model.

Evaluating Obesity Prevention Efforts: What Have We Learned? — Documents the proceedings from a January 2015 convening of evaluators from the California Endowment, Kaiser Permanente, Nemours, the Robert Wood Johnson Foundation, and the W.K. Kellogg Foundation who met in Oakland, California to discuss what was working with their initiatives to reduce the prevalence of childhood obesity. The discussion focused on a variety of interventions in early care and education, schools, communities, and food systems. The findings reported are limited to the information that was shared at that meeting and add to the evidence base for strategies for the prevention and control of childhood obesity.

Building a Successful Farm to School Movement: One Person, One Plot, One Policy at a Time — Documents a case study of a successful, collaborative effort to offer fresh, local, and unprocessed foods to students in a rural Colorado county. Details one effort to bring locally produced foods into school cafeterias and provide hands-on learning activities such as gardening, cooking classes, and food-related education in schools.

Kaiser Permanente: A History of Prevention and Collaboration with Schools [Presentation] — Presented rationale and strategies for Kaiser Permanente’s collaboration on school health initiatives, including the Total Health Framework and the Thriving Schools initiative.

Community‐Level Obesity Prevention Initiatives — Reviews the evidence to date on the impact of community-level initiatives to prevent obesity and offers suggestions for both future intervention and evaluation design for this type of community initiative.

Engaging Youth in Learning about Healthful Eating and Active Living: An Evaluation of Educational Theater Programs — Presents results on the impact of the Kaiser Permanente Educational Theatre Program. There were statistically significant increases in knowledge pre/post, and knowledge was retained over the short term.

Kaiser Permanente’s Farmers’ Market Program: Description, Impact, and Lessons Learned — Describes the Kaiser Permanente farmers market program and summarizes the results of a patron survey conducted in 2010 among 2,435 market patrons. The markets appear to have an impact on what people are eating with three-quarters of all patrons reporting eating more fruits and vegetables as a result of coming to the market.

Creating Physical Activity-Promoting Community Environments: Time for a Breakthrough — Argues that increasing the amount of physical activity Americans get to recommended levels will require changes in community environments so that people can be more active as part of everyday life. Recent and pending federal legislation can provide the investments and other support necessary to make these changes.

Community Health Initiative (CHI) Interim Report — Summarizes evaluation findings to date for cross-site Community Health Initiatives; including, baseline data for the population-level surveys and provides preliminary data on the community change strategies.

Population Dose Methodology

Dose Matters — Describes the concept of “population dose,” an approach to strengthening and evaluating the impact of complex multi-sector, multilevel, place-based initiatives. Reports on what is promising about the approach while recognizing the measurement and other challenges that still lie ahead. The concept emerged from ongoing evaluations of Kaiser Permanente’s Community Health Initiative investments.

Healthy Dose: A Toolkit for Boosting the Impact of Community Health Strategies — Provides an overview of the dose methodology and interactive tools to promote understanding of how to apply dose to community health intervention strategies.

Lessons Learned from Kaiser Permanente’s Community Health Initiative (CHI) Evaluation — Presents the population dose methodology and Community Health Initiatives evaluation results to date to an IOM roundtable on obesity solutions. Cross-sector work on obesity prevention

Using the Concept of “Population Dose” in Planning and Evaluating Community-Level Obesity Prevention Initiatives — Describes the concept of “population dose”- combining reach and strength to estimate the impact of an obesity-prevention strategy on risk behaviors within a target population. Provides a definition and examples of measuring population dose, reviews ways of increasing dose, and illustrates how the concept of has been used in the Kaiser Permanente Community Health Initiatives.

Kaiser Permanente’s Community Health Initiative in Northern California: Evaluation Findings and Lessons Learned — Describes evaluation findings and lessons learned from the Kaiser Permanente Healthy Eating Active Living – Community Health Initiative. The population-level results were inconclusive overall, but showed positive and significant findings for four out of nine comparisons where ‘‘high-dose’’ strategies were implemented, primarily physical activity interventions targeting school-age youth.

Best Practices in Evaluating Community-wide Obesity Prevention Initiatives

Evaluating Progress of Community-Level Obesity Prevention Initiatives — Describes the current state of methods for evaluating the effectiveness of community-wide obesity prevention initiatives and present recommendations for best practices and suggestions for common metrics.

The Kaiser Permanente Community Health Initiative: Overview and Evaluation Design — Gives an overview of the Kaiser Permanente Community Health Initiative — created in 2003 to promote obesity-prevention policy and environmental change in communities served by Kaiser Permanente — and describe the design for evaluating the initiative. The evaluation assesses impact by measuring intermediate outcomes and conducting pre- and post-tracking of population-level measures of physical activity, nutrition, and overweight.

Approaches to Measuring the Extent and Impact of Environmental Change in Three California Community-Level Obesity Prevention Initiatives — Describes the approaches used to measure the extent and impact of environmental change in 3 community-level obesity-prevention initiatives in California. Focused on measuring changes in the community environment and assessing the impact of those changes on residents most directly exposed to the interventions.

A Qualitative Exploration of Alternative Strategies for Building Community Health Partnerships: Collaboration Versus Issue-Oriented Approaches — Presents an exploratory analysis relating the structure of partnerships to the types of issues they address. Contrasts “collaboration-oriented” partnerships that included substantial resident involvement and focused on producing immediate, concrete community improvements, and “issue-oriented” partnerships that focused on a single, typically health-related issue with multilevel interventions that included a focus on higher-level systems and policy change.

Using PhotoVoice as an Evaluation Tool

Using PhotoVoice as a Participatory Evaluation Tool in Kaiser Permanente’s Community Health Initiative — Describes the use of Photovoice as a participatory evaluation method in the KP sponsored CHI, including several ways in which the KP CHI Photovoice evaluation modified the original Photovoice methodology for use as an evaluation tool.

Promoting Policy and Environmental Change Using Photovoice in the Kaiser Permanente Community Health Initiative — Summarizes the process, key themes, and impacts for a Photovoice project implemented in three communities in Colorado. Photovoice projects have been implemented across the nation as part of Kaiser Permanente’s Community Health Initiatives. Also describes how this Photovoice project was different than a traditional model, since policy makers were engaged, leading to policy changes in the communities.

Photovoice – Kaiser Permanente Community Health Initiatives — Describes the Kaiser Permanente’s Community Health Initiatives, the Photovoice process, examples of communities using Photovoice and how communities were able to make changes in their community for healthier eating and more active living opportunities.

Other Sources referencing Kaiser Permanente’s Community Health Initiatives

Obesity Prevention Approaches/Strategies

Vitality Institute’s Business Case Study: Kaiser Permanente Community Health Initiatives — Highlights Kaiser Permanente’s Community Health Initiative in a case study exploring the role of a health system in promoting health at every touch point in communities, beyond the walls of the hospitals and clinics.

Harvest for Healthy Kids Pilot Study: Associations Between Exposure to a Farm-to-Preschool Intervention and Willingness to Try and Liking of Target Fruits and Vegetables Among Low-Income Children in Head Start — Presents findings from the Harvest for Healthy Kids pilot study to promote children’s greater willingness to try and like target foods.

Communitywide Strategies Key to Preventing Childhood Obesity — Argues that effective interventions to prevent obesity require more than educating individuals. To bring about change, we must deploy tactics at multiple levels, from community facilities like parks and bike paths to foods offered in schools. University of California Cooperative Extension has helped evaluate large-scale community-based obesity prevention programs and has experience aligning county nutrition programs with new dietary guidelines.

An Objective Assessment of Children’s Physical Activity During the Keep It Moving! After-School Program — Assesses the physical activity of third-, fourth-, and fifth-grade children in the Keep It Moving! (KIM) after-school physical activity program, which was implemented in an ethnically diverse and low socioeconomic status school district in Colorado Springs, Colorado.

Planning and Development of the Better Bites Program: A Pricing Manipulation Strategy to Improve Healthy Eating in a Hospital Cafeteria — Gives an overview of the Better Bites program in Colorado Springs, CO, a hospital cafeteria nutrition intervention strategy, that was developed by combining evidence-based practices with hospital-specific formative research, including key informant interviews, the Nutrition Environment Measures Study in Restaurants, hospital employee surveys, and nutrition services staff surveys.

Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making — Presents a practical, action-oriented framework to guide the use of evidence in decision making about obesity prevention policies and programs: the L.E.A.D. framework, short for Locate evidence, Evaluate it, Assemble it, and Inform Decisions. Decision makers, their intermediaries, and researchers can apply the L.E.A.D. framework to inform the decisions that must be made about obesity prevention.

Discretionary Calorie Intake a Priority for Obesity Prevention: Results of Rapid Participatory Approaches in Low-income US Communities — Presents findings showing that energy from salty snacks, candy, cookies and sugar-sweetened beverages was more strongly related to BMI than reported physical activity, fruit or vegetable consumption.

Recommended Community Strategies and Measurements to Prevent Obesity in the United States: Implementation and Measurement Guide — Summarizes a CDC initiated effort – the Common Community Measures for Obesity Prevention Project – to identify and recommend a set of strategies and associated measurements that communities and local governments can use to plan and monitor environmental and policy-level changes for obesity prevention.

Progress in Preventing Childhood Obesity: How do We Measure Up? — Presents follow-up information related to “Preventing Childhood Obesity: Health in the Balance” report. The Robert Wood Johnson Foundation asked the IOM to assess progress in childhood obesity prevention actions across a variety of sectors and to engage in a dissemination effort that would promote the implementation of the 2005 report’s findings and recommendations through three regional symposia

Health Plans’ Role in Preventing Overweight in Children and AdolescentsDescribes how U.S. health plans can promote evidence-based behavioral-change strategies by directly intervening in medical settings and by supporting efforts to modify the environments in which young people live, study, and play. Also describes a variety of innovative initiatives launched in recent years by health plans to address overweight among children and adolescents.

Preventing Childhood Obesity: Health in the Balance — Summarizes the evidence around the problem of childhood obesity, health implications, economic implications, and sets out goals for childhood obesity prevention, recommendations, and individual, as well as, cross-sectoral efforts.

Approaches to Improving Population Health

A Perspective on Public-Private Collaboration in the Health Sector — Explores multi-sector collaboration, why it’s imperative, the obstacles that can impede it and the thoughts about addressing these obstacles. Kaiser Permanente’s Community Health Initiatives is highlighted as an example of a multi-sector collaborative that has achieved results.

Improving Community Health through Hospital-Public Health Collaboration: Insights and Lessons Learned from Successful Partnerships — Suggests ways to identify and examine successful partnerships involving hospitals, public health departments, and other stakeholders who share commitment to improving the health of communities they serve and ascertain key lessons learned from their collective experience.

Using the Model to Plan, Implement, and Evaluate the Effects of Environmental Change Approaches to Enhancing Population Health Gives an overview of the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, which provides a practical means of evaluating health interventions. Discusses benefits and challenges of applying RE-AIM to evaluate built environment strategies and recommends modest adaptations of the model to do so.

Making Better Use of the Policies and Funding We Already Have —Argues that population health reform can be enhanced by assessing whether we have made the most of policies and resources already available. Opportunities to promote population health independent of major changes in resources or public authority include: enforcing laws already in effect; clarifying and updating the application of long-standing policies; and facilitating access to programs by everyone who is eligible for them.