Evaluating Policy and Environmental Change Interventions: Building Public Health Capacity

BACKGROUND:  Across Iowa, chronic diseases create an enormous strain on personal, public, and community health in terms of cost, lost productivity, and quality of life. During the past two decades, the percentage of Iowans diagnosed with a chronic disease (CD) has increased steadily; 87% of Iowa adults now report having at least one CD (e.g., diabetes, heart disease/stroke). A majority of Iowa adults also report associated risk factors for chronic diseases including overweight/obesity, inadequate nutrition, and insufficient physical activity (BRFSS, 2012). In response to this growing health crisis, the Iowa Department of Public Health (IDPH) is moving from a focus on community education and individual behavior change to population-based interventions that seek to modify physical and nutrition settings, plus policies and environmental changes to create communities where the healthy choice is the simplest and most straightforward option.

METHODS:  State public health entities are increasing charged with implementing interventions focused on policy and environmental changes specifically related to CD. Implementing policy and environmental changes is complex and evaluating them often requires public health practitioners to develop additional skills. IDPH has developed a multi-pronged approach to building practitioners' skills and capacity to evaluate policy and environmental changes implemented in the Iowa Partnership for Chronic Disease Prevention and Control (IA PCDPC) grant. IDPH offered training to state-level practitioners to build their capacity to engage in policy, systems and environmental change strategies statewide.

RESULTS: Capacity building activities provided to state employees included: detailing an evaluation framework that included essential components of policy and environmental changes, creating logic models, drafting evaluation plans, and evaluating policy and environmental changes. The IDPH framework for the IA PCDPC will be illustrated to evaluate the formulation, enactment, and implementation of state-level policies and environmental changes. Examples will be presented related to regulating foods and beverages in public schools and initial findings will be presented from the evaluation of IDPH staff responses to its capacity building framework, tools, and trainings.

CONCLUSIONS:  Realizing policy and environmental changes is a multifaceted process.  Quantifying and assessing policy and environmental changes has necessitated the development of skills and competencies among state-level public health practitioners. As part of the IA PCDPC, the IDPH established a functional, versatile method to enhance competency and capacity among public health practitioners.