Objective: To examine the association between fruit and vegetable access in the community and change in fruit and vegetable consumption among participants in community-based health promotion programmes. Design: Fruit and vegetable consumption and perceived access to fresh fruit and vegetables were measured by self-administered questionnaires at programme start, end and 1-year follow-up. Community produce availability was determined by grocery store assessments measuring the display space devoted to fruit and vegetable offerings, as well as price, variety and freshness. A total of nine communities were studied; 130 participants completed the fruit and vegetable portions of the questionnaires and could be linked to grocery store assessments. Results: Participants made modest but significant increases in fruit and vegetable consumption from programme start to end: the average increase was 2?88 (95 % CI 1?52, 4?25) servings weekly; the average increase from start to follow-up was 2?52 (95 % CI 1?09, 3?95) servings weekly. Greater perceived access to fruits and vegetables was significantly associated with higher increases in fruit and vegetable consumption from programme start to programme end. Greater availability of produce was associated with greater increases in fruit and vegetable servings from programme start to programme end as measured by store assessments. Conclusions: Environmental factors, such as access to fruits and vegetables, can modify the effects of community interventions. Interventions with the goal of increasing fruit and vegetable consumption should consider focusing on increasing access to fresh fruits and vegetables in target communities. Similarly, researchers may want to study access as an intervention, not just a contextual variable.
Community-based organizations (CBOs), typically small and underfunded with transient staff members, are told by funders to care for clients and verify program value. To assist CBOs with evaluations that speak to program effectiveness, many funders wish to expand the evaluation capacity of CBO staff members so that evaluation will occur as long as programs exist. In this article, the authors argue that sustainable program evaluation is unlikely when resources are devoted to training staff members to conduct evaluation in house or when money is spent for a typical external evaluation. Instead, the authors recommend a model they name “insourcing.” The insourcing model, a cross between in-house and outsourced evaluation, spreads the cost burden of the external evaluation across many CBOs while keeping evaluation in the hands of those trained in the art of evaluation. Insourcing also reduces the staff burden inevitable with internal evaluation and has the greatest potential to sustain. This article compares insourcing with other evaluation types and discusses circumstances in which insourcing could be beneficial.
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