Process Evaluation of a Regional Public Health Model to Reduce Chronic Disease Through Policy and Systems Changes, Washington State, 2010–2014

Abstract

IntroductionAlthough the regionalization of public health systems has been well documented in the case of emergency preparedness, there is little literature on the application of regional approaches to other aspects of public health. From 2011 through 2014 the Washington State Department of Health implemented a Community Transformation Grant to support community-level policy and systems changes to decrease chronic disease risk factors and increase access to clinical preventive services. The Department of Health implemented the grant through a regional model, grouping 32 of the state’s 35 local health jurisdictions into 5 regions. Our process evaluation identifies the challenges and facilitators to Community Transformation Grant planning and implementation. MethodsWe conducted 34 key informant interviews with people directly involved in the implementation of the Community Transformation Grant. We interviewed state and local partners, including representatives from each region, the Department of Health, external consultants, and regional partners. We collected data from October 2013 through July 2014.ResultsChallenges for planning, building, and implementing a regional model for chronic disease prevention included stakeholder buy-in, regional geography, and communication; facilitators included shared regional history and infrastructure, strong leadership, collaborative relationships, shared vision and goals, sufficient funding, and direct technical assistance and training.ConclusionLessons learned in Washington State provide a foundation for other states interested in using a regional approach to reduce chronic disease risk. Policy and systems changes require adequate time, funding, and staffing. States and funders should work closely with local leaders to address these challenges and facilitators.

Strengthening complex systems for chronic disease prevention: a systematic review

“…There were plentiful and broad descriptions regarding critical success factors of multisectoral collaboration or partnerships [47–50, 54, 77, 78]. It is beyond the scope of this paper to elaborate in detail on success factors, however, the need for effective mechanisms, structures, processes, and facilitative infrastructure for coordination, collaboration, and relationship building were widely discussed [16, 19, 28, 74, 77, 79–82]. Woulfe et al [77] maintained that collaborative partnerships were in essence the system for CDP.…”

“…Leadership at multiple levels was also identified. Although global [37, 94], state [82, 104] and local levels [40] were discussed, it was national- level leadership that was most frequently reported as important to effective systems for CDP [17, 44, 45, 54, 76, 97, 110, 111]. National leadership was considered critical to oversee and integrate strategic policy frameworks [5, 44, 74], align vision, strategy and mission [19, 83] in integrated plans and joined up governance structure [46, 51, 58, 65, 67, 69, 74, 76, 79, 112–116].…”

“…Resource development figured prominently in terms of the need to mobilize core, adequate or appropriate resources and long-term investment [27, 32, 37, 42, 54, 65, 80, 101, 129, 137]. Beyond discussing resources for the implementation of desired actions and research [74] resources to build collaborative capacity were called for to facilitate synergistic effects of linked actions [30, 82], shared or leveraged cross sectoral assets [42, 59, 89] and system integration and coordination [29].…”

Prevention Research Center Collaborations With State Departments of Health: Washington State

“…The HPRC and DOH have published assessment and evaluation work related to colorectal cancer screening, 1,2 prostate cancer and informed decision making, 3,4 tobacco control, 5 and Washington State's implementation of the Community Transformation Grant. 6 These projects involved needs assessment through primary data collection or secondary data analysis, 1,3,5 and evaluating intervention work performed by DOH or their Grantees. 2,4,6 The resulting collaborative publications serve to share findings, and highlight DOH's community partners that are integral to their health programming efforts and population impact.…”

“…6 These projects involved needs assessment through primary data collection or secondary data analysis, 1,3,5 and evaluating intervention work performed by DOH or their Grantees. 2,4,6 The resulting collaborative publications serve to share findings, and highlight DOH's community partners that are integral to their health programming efforts and population impact.…”