Purpose: This study describes setting and community population health physical activity (PA) effectiveness-implementation outcomes of a two-wave whole-of-community systems intervention trial.

Methods: Rural communities (n=2/wave) were randomized to a Wellscapes or Collective Impact (CI) condition. Within communities, organized group setting meetings (e.g., sport team practices) were video-recorded, and simultaneously, accelerometer data were collected from attending children. Meetings were time-segmented into smaller social system units (sessions) based on purpose (e.g., PA). Primary effectiveness and implementation outcomes included change in meeting percent time (%time) in moderate-to-vigorous PA (MVPA) and number and duration of PA sessions, respectively. Children self-reported the secondary population health PA outcome using the Youth Activity Profile each fall and spring (2018–2023). Students’ responses were used in an algorithm to estimate daily, in-school, and out-of-school PA minutes. Due to COVID-19, data collections ended early in Wave 1 (fall 2018–March 2020), and video/accelerometer data were not collected in Wave 2 (fall 2021–spring 2023). Mixed effects models examined the intervention effect on group meeting %time in MVPA and PA session implementation and self-reported child population PA.

Results: For outcomes limited to Wave 1, Wellscapes increased (p=0.03) school setting %time in MVPA (3.2±0.6% to 6.3±1.1%) compared to CI (4.9±0.9% to 4.6±08%) and increased (p=0.04) implemented duration (minutes) of PA sessions (6.5±1.6 to 16.2±4.1) compared to CI (20.7±5.2 to 18.0±4.5). The condition-by-time population health PA Youth Activity Profile outcomes were not significant across waves. However, for Wave 1, the Wellscapes community had a greater increase (p=0.005) in in-school MVPA minutes (29.2±0.4 to 30.4±0.4) compared to the Wave 1 CI community (21.9±0.4 to 21.5±0.4). Significant condition-by-time effects were not found for Wave 2 spring 2022–spring 2023.

Conclusions: The Wellscapes intervention may have contributed to effectiveness-implementation during school compared to the CI condition. The absence of setting-level data collection and feedback in Wave 2 may have contributed to the lack of intervention effect on overall PA outcomes across waves. More research is needed to identify the characteristics of community systems that improve out-of-school PA.

Purpose:

Local health promotion efforts can bring stakeholders across a community together to create a community-engaged system that coordinates local solutions to impact community systems to improve population health. This study examines differences in the design of community-engaged coordination system structure and processes in rural communities.

Methods:

Four rural communities randomized to the Wellscapes (WS) or Collective Impact (CI) condition (Wave 1, 2018-2021, n=2, Wave 2, 2021-2023, n=2) formed a local community coordination system to improve child population physical activity. WS followed polycentric, heterarchical structure principles to form the community coordination system, while CI followed standard, hierarchical coordination system principles. To assess coalition structure (i.e., role of coalition members, grasstops or grassroots stakeholder) and community system coordination processes (e.g., trust, autonomy, collective efficacy), a self-report survey was administered to coalition members each spring (Wave 1, 2019, 2020; Wave 2, 2022,2023). Descriptive statistics examined coalition structure and mixed effects models examined the intervention effect on coordination processes.

Results:

From post-baseline infrastructure development year (WS, n=25; CI n=17) to post-intervention year (WS N=32, CI N=19), the percent of self-identified grasstops or grassroots changed in both WS (grassroots = 36% to 64%) and CI (grassroots = 41.2% to 31.6%). From baseline to follow-up, there were no significant differences in coalition trust (WS x̄=3.14, x̄=3.14; CI x̄=4.06, x̄=3.82), collective efficacy (WS x̄=3.08, x̄=3.03; CI x̄=3.81, x̄=3.48) or autonomy (WS x̄=3.85, x̄=3.85; CI x̄=4.24, x̄=3.99). Influence measures added for Wave 2 at post-intervention indicated no significant differences in the level of influence (power) community entities had on the WS (x̄=2.8±0.9) and CI (x̄=3.1±0.7) coalitions.

Conclusions:

Despite no significant differences in coordination process measures, a descriptive shift in grassroots membership and lower levels of community entity influence in the WS condition suggests a polycentric coordination system was established. These findings support the need for a larger study of the community coordination system principles that impact community entity agency autonomy and diversity of power in the production of child physical activity services.

Purpose: This study compares the Wellscapes Investigate-Design-Practice-Reflect (IDPR) community development process with Collective Impact’s planning and accountability process on coalition-driven child physical activity (PA) policy, system, and environmental (PSE) changes in rural communities. 

Methods: Coalitions in four rural communities (Wave 1, n=2 non-Hispanic/White; Wave 2, n=2 concentrated Hispanic) were randomized to the Wellscapes (WS) or Collective Impact (CI) community-engaged system processes. WS coalitions followed a rapid cycle IDPR development process consisting of 1) community asset, place-based, and social influence mapping (Investigate), (2) developing a roadmap and PA opportunity prototypes (Design), (3) implementing prototypes (Practice), and (4) reviewing data feedback from practices piloted (Reflect). CI coalitions were facilitated through a standard quality improvement CI process composed of (1) developing a common agenda, (2) creating an action and accountability plan, (3) executing assigned action steps, and (4) reviewing data feedback from executed plan. The research team facilitated the community-engaged processes during a baseline infrastructure development and an intervention academic year. Wave 1 (n=2) communities’ work (Sept. 2018–May 2020) was disrupted by COVID-19 in March 2020. Wave 2 (n=2) communities’ work occurred during Sept. 2021–May 2023. Informed by developed PSE-coding schemes, implementation activities were evaluated using qualitative content analysis by three independent researchers from multi-method data collection (i.e., direct observation, document analysis, stakeholder interviews).

Results: Coalitions guided by the WS process (IDPR) implemented more collective policy (W1, n=1; W2, n=3), systems (W1, n=3; W2, n=4), and environmental (W1, n=3; W2, n=6) changes than coalitions guided by CI, which implemented two policy (W1, n=1; W2, n=1), six systems (W1, n=3; W2, n=3), and seven environmental (W1, n=4; W2, n=3) changes. We identified one overarching theme: WS coalitions developed local solutions by engaging community-wide stakeholders and assets to create new PA opportunities, while CI coalitions relied on existing membership to select and implement programs.

Conclusions: Manipulation of community-engaged system processes resulted in differences in coalition-driven PA PSE change strategies. The IDPR process may encourage local entrepreneurial efforts utilizing existing resources through the exploration of the local community wellness landscape while CI may encourage traditional program selection and implementation by following a plan.