Legal preparedness for obesity prevention and control: a framework for action

Leaders' Experiences in Planning, Implementing, and Evaluating Complex Public Health Nutrition Interventions

OBJECTIVE

To explore California local health department leaders' experiences planning, implementing, and evaluating nutrition promotion and obesity prevention programs for low-income families.

DESIGN

Qualitative, cross-sectional study using semi-structured in-depth interviews and panel interviews conducted in 2015-2016.

SETTING

California local health departments (LHDs) funded by the California Department of Public Health to implement Supplemental Nutrition Assistance Program-Education (SNAP-Ed).

PARTICIPANTS

The authors recruited SNAP-Ed leaders from all 58 California LHDs implementing SNAP-Ed. Leaders from 49 LHDs participated: 36 in hour-long, in-depth interviews and 13 in 1 of 3 90-minute group panel interviews.

PHENOMENON OF INTEREST

Processes, facilitators, and barriers connected to delivering SNAP-Ed reported by leaders in planning, implementing, and evaluating local programs.

ANALYSIS

Interviews were transcribed, coded, and analyzed using Dedoose software.

RESULTS

Leaders grappled with introducing, implementing, and integrating policy, systems, and environmental change interventions (PSEs). Information used to make planning decisions varied widely across LHDs. Partnership with nontraditional organizations was described as a resource- intensive, nonlinear process with recognized potential for benefit. Rural programs reported specific and different experiences compared with their urban counterparts.

CONCLUSIONS AND IMPLICATIONS

Implementing new, complex interventions to improve diet and activity environments and behaviors is both exciting and challenging for local leaders. They expressed a desire for additional resources and capacity building to facilitate success, particularly related to policy, systems, and environmental change programs. Attention to the specific needs of rural counties is needed.

Policy, systems, and environmental approaches for obesity prevention: a framework to inform local and state action

The public health literature has not fully explored the complexities of the policy process as they relate to public health practice and obesity prevention. We conducted a review of the literature across the policy science and public health fields, distilled key theories of policy making, and developed a framework to inform policy, systems, and environmental change efforts on obesity prevention. Beginning with a conceptual description, we focus on understanding three domains of the policy process: the problem domain, the policy domain, and the political domain. We identify key activities in the policy process including the following: (a) assessing the social and political environment; (b) engaging, educating and collaborating with key individuals and groups; (c) identifying and framing the problem; (d) utilizing available evidence; (e) identifying policy solutions; and (f) building public support and political will. The article provides policy change resources and case studies to guide and support local and state efforts around obesity prevention.

Assessing competencies for obesity prevention and control

Obesity is the result of people consistently consuming more calories than they expend. A complex interaction of social and environmental conditions affects both energy consumption and physical activity levels. These conditions include, but are not limited to the following factors: the availability of affordable and healthy food; price disparities between healthy and less healthy foods; access to or perceived safety of recreation facilities; and the conduciveness of the physical environment to active modes of transportation, such as walking and biking. As outlined in the “Assessing Laws and Legal Authorities for Obesity Prevention and Control” paper in this supplement issue, laws and government policies in the United States influence nearly all of these social and environmental factors.