Multi-Level, Multi-Component Approaches to Community Based Interventions for Healthy Living—A Three Case Comparison

Abstract

There is increasing interest in integrated and coordinated programs that intervene in multiple community settings/institutions at the same time and involve policy and system changes. The purpose of the paper is to analyse three comparable cases of Multi Level, Multi Component intervention programs (ML-MC) from across the world in order to give recommendations for research, policy and practice in this field. Through the comparison of three cases: Health and Local Community (SoL-program), Children’s Healthy Living (CHL) and B’More Healthy Communities for Kids (BHCK), this paper examines the potential of ML-MC community-based public health nutrition interventions to create sustainable change. The paper proposes methodology, guidelines and directions for future research through analysis and examination strengths and weaknesses in the programs. Similarities are that they engage and commit local stakeholders in a structured approach to integrate intervention components in order to create dose and intensity. In that way, they all make provisions for post intervention impact sustainability. All programs target the child and family members’ knowledge, attitudes, behavior, the policy level, and the environmental level. The study illustrates the diversity in communities as well as diversity in terms of which and how sites and settings such as schools, kindergartens, community groups and grocery stores became involved in the programs. Programs are also different in terms of involvement of media stakeholders. The comparison of the three cases suggests that there is a need to build collaboration and partnerships from the beginning, plan for sufficient intensity/dose, emphasize/create consistency across levels and components of the intervention, build synchronization across levels, and plan for sustainability.

Association between multi-component initiatives and physical activity-related behaviors: interim findings from the Healthy Schools Healthy Communities Initiative

“…Given that resources are often limited, careful consideration of the strategies within any given MCI should be taken. In a review of three MCI case studies, Mikkelsen et al [37], found that using the full range of strategies are key to a successful implementation, and efforts to increase knowledge, enhance services, modify access, and change broader conditions should all be included. The HSHC MCIs included a variety of educational events/programs, as well as policy, practice, and environmental changes, but there were over three times more programs and events as compared to policy, practice, and environmental changes (1,703 vs. 471, respectively).…”

Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores

“…Additionally, formative research and/or adaptive intervention approaches should be conducted to understand how to influence product availability and placement within stores given previous evidence demonstrating the relationship between these dimensions and dietary behaviors [11,12,37,67]. One potential way to effectively manipulate multiple aspects of the in-store environment is by involving multiple partners [58,68]. For example, FV distributors and/or farmers could provide store owners/managers with technical assistance and training in acquiring and maintaining fresh FVs.…”

Empowering One Community at a Time for Policy, System and Environmental Changes to Impact Obesity

“…12 Similar to ArCOPs experience, research has shown that involving key stakeholders in the planning and implementation of the intervention is essential for investment in the program, and is required for longterm program success and sustainability. 4,[13][14][15] Furthermore, the CDC also emphasizes the importance of local governments in creating physi- times (May to July) to discuss: opportunities for providing the community with health-related information; how to deliver the messages; how to brand the delivery; and development of a motto (eg, "Because you matter"). The Council decided to utilize the logo and information from a defunct website that was designed to address health issues and opportunities in the Policy, System and Environmental Approaches to Impact Obesity -Betancourt et al cal activity and food environments that promote health for their communities.…”

“…3 Thus, there is increasing interest in programs that focus on changes at the environmental, system and policy levels. 4 In 2003, Arkansas became the first state in the United States to enact a law to create a comprehensive multipronged approach to bring families, schools and communities together to combat the epidemic of obesity. 5 From initial multilevel initiatives, the Arkansas Coalition for Obesity Prevention (ArCOP) was formed in 2007.…”