The Kaiser Permanente Community Health Initiative: Overview and Evaluation Design

摘要

We provide an overview of the Kaiser Permanente Community Health Initiative—created in 2003 to promote obesity-prevention policy and environmental change in communities served by Kaiser Permanente—and describe the design for evaluating the initiative. The Initiative focuses on 3 ethnically diverse northern California communities that range in size from 37 000 to 52 000 residents. The evaluation assesses impact by measuring intermediate outcomes and conducting pre- and posttracking of population-level measures of physical activity, nutrition, and overweight. The focus of public health practitioners on policy and environmental change in obesity- prevention efforts 1 – 6 has led to the development of comprehensive community initiatives designed to produce a sustained effort by a broad range of community stakeholders. 7 , 8 However, there are few credible studies demonstrating that comprehensive community initiatives are effective in lowering obesity rates, 9 , 10 and therefore, evaluation of these initiatives is critical. This article gives an overview and describes the evaluation design of one such initiative—Kaiser Permanente's Community Health Initiative (CHI), created in 2003 to promote obesity-prevention policy and environmental change in communities served by Kaiser Permanente. The core CHI principles encompass a place-based focus; an emphasis on interventions involving policy and environmental change; collaboratives with representatives of sectors such as health care, neighborhoods, schools, and work sites; community engagement and ownership; and systematic evaluation. 11 Kaiser Permanente is sponsoring initiatives containing these elements in 30 sites. In this article, we concentrate on 3 northern California communities whose initiatives were implemented between 2005 and 2010.