Healthy Kids, Healthy Communities: Program Evaluation

Faces of three smiling girls.

This evaluation highlights successful plans, processes, and strategies from Healthy Kids, Healthy Communities for system, policy, and environmental changes aimed to increase active living and healthy eating.

About Health Kids, Healthy Communities

In 2007, the Robert Wood Johnson Foundation (RWJF) announced a bold and unprecedented commitment of $500 million to reverse the epidemic of childhood obesity by 2015—especially in communities at greatest risk based on income, race, ethnicity, and geographic location. To support this work, the Foundation launched an array of complementary initiatives aimed at building the evidence base; testing advocacy approaches; and supporting on-the-ground action to reverse the childhood obesity epidemic. Healthy Kids, Healthy Communities (HKHC), a five-year, $33.4 million national program, was one of the Foundation's earliest such investments. Building on previous successes, HKHC was designed to address the policies, systems, and environments that make it easier for low-income children and their families to engage in physical activity and play, and to access healthy food in their communities.

As part of its strategy, RWJF funded 49 multidisciplinary partnerships across the country, with a special focus on 15 southern states where health disparities were most significant. The selection of Active Living By Design to lead the national program office and Transtria, LLC, to lead the evaluation leveraged these organizations' experience in addressing the systemic issues that contribute to physical inactivity and unhealthy eating—using a broader healthy community lens. Key elements of HKHC included funding; ongoing technical assistance and consultation; a peer learning network; and participatory evaluation.

Evaluating HKHC

Beginning in March 2009, multiple evaluation methods were designed to assess policy, system, and environmental changes as a result of the community partnerships’ efforts, including the HKHC Community Dashboard website; a partnership and community capacity survey; and group model building.

Evaluation Goals/Objectives

Transtria LLC and Washington University Institute for Public Health received funding from RWJF to evaluate the HKHC national program. The evaluation team, led by Tina Kauh, senior program officer at RWJF had the following objectives:

1) to coordinate data collection for the evaluation through the web-based project management system (HKHC Community Dashboard) and provide training and technical assistance for use of this system; 2) to guide data collection and analysis through use of the Assessment & Evaluation Toolkit; 3) to conduct a quantitative cross-site impact evaluation among a subset of community partnership sites; and 4) to conduct a qualitative cross-site process and impact evaluation among all 49 community partnership sites.

Evaluation Methodology

The cross-site strategies implemented by HKHC were evaluated through relevant methods (policy assessment; environmental audits; photos or videos; direct observation) and consistent measures, where feasible. Data collection capitalized on existing assessment efforts in place across all 49 HKHC community partnerships and new information collected on site visits by the evaluation team. Other methods (e.g., qualitative data from the HKHC Community Dashboard) and innovative methods (e.g., cost assessment, group model building) were intended to supplement these findings.

Evaluation Findings

  • Community partnerships generated an additional $137,390,495.77 in matching funds to the $17,948,003.53 provided by the RWJF grant.

  • A total of 616 assessments were completed across all HKHC sites, with about half (320) conducted to benefit active living and the other half (296) directed toward healthy eating.

  • Policy, practice, or environmental changes were most prevalent in nutrition-related (530) and physical activity-related (419) changes in childcare settings.

Lessons Learned / Conclusion

The evaluation of HKHC was intended to highlight successful plans, processes, and strategies for system, policy and environmental changes to increase active living and healthy eating and identify challenges encountered or failed approaches, with a focus on children and their families in racial/ethnic and lower-income populations with disproportionately high rates of childhood obesity.

“This exploratory analysis provided a method and typology for increasing understanding in the field related to the reach, dose, and impact of policy, practice, and environmental changes promoting healthy eating and active living in order to reduce childhood overweight and obesity.These findings suggest potential avenues to increase understanding related to the common community structures (e.g., social determinants, community resources); processes (e.g., partners engaged, community members involved, resources acquired); and strategies that lead to greater reach, dose, and impact of policy, practice, and environmental changes to increase active living and healthy eating among the entire population and high-risk groups.”