Evaluating Cross-Cutting Approaches to Chronic Disease Prevention and Management: Developing a Comprehensive Evaluation

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Inputs to the model are funding, guidance, and support from DDT, DHDSP, DNPAO, and DPH. The model starts with activities: partnership engagement, workforce development, guidance and support, strategic communication, surveillance/epidemiology, and evaluation.

These activities lead to basic strategies: 1) promote the adoption of food service guidelines/nutrition standards, which include sodium; 2) promote the adoption of physical education/physical activity (PE/PA) in schools; 3) promote adoption of PA in early care and education (ECE) and worksites; 4) promote reporting of blood pressure and A1c measures; and as able, initiate activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure; 5) promote awareness of high blood pressure among patients; 6) promote awareness of prediabetes among people at high risk for type 2 diabetes; and 7) promote participation in DSME programs.

These basic strategies lead to basic accomplishments: 1) increased adoption of healthy food service guidelines/nutrition standards; 2) increased adoption of PE/PA in schools; 3) increased adoption of PA in ECE and worksites; 4) increased reporting of blood pressure and A1c measures; and as able, increased initiation of activities that promote clinical innovations, team-based care, and self-monitoring of blood pressure; 5) increased awareness of high blood pressure among patients; 6) increased awareness of prediabetes among people at high risk for type 2 diabetes; and 7) Increased participation in DSME programs (officially recognized, accredited, and/or licensed).

The initial activities and basic strategies, which demonstrated success in accomplishing activities and strategies, lead to enhanced strategies, which fall into 3 categories: environmental approaches to promote health and support and reinforce healthful behaviors, health system interventions to improve the effective delivery and use of clinical and other preventive services, and community clinical linkages to support CVD and diabetes prevention and control efforts. The environmental approaches are 1) access to healthy food and beverages; 2) food service guidelines/nutrition standards where foods and beverages are available, with guidelines and standards that address sodium; 3) supportive nutrition environments in schools; 4) physical activity access and outreach; 5) physical activity in ECE; 6) quality physical education and physical activity in K–12 schools; and 7) access to breastfeeding-friendly environments. Health system interventions are quality improvement processes in health systems and use of team-based care in health systems. Community clinical linkages are 1) use of diabetes self-management programs in community settings; 2) use of lifestyle intervention programs in community settings for the primary prevention of type 2 diabetes; 3) use of health-care extenders in the community in support of self-management of high blood pressure and diabetes; 4) use of chronic disease self-management programs in community settings; and 5) policies, processes, and protocols in schools to meet the management care needs of students with chronic conditions.

These enhanced strategies lead to short-term outcomes: 1) increased state, community, worksite, schools, and ECE environments that promote and reinforce healthful behaviors and practices across the life span related to diabetes, cardiovascular health, student health, physical activity and healthful foods and beverages, obesity, and breastfeeding; 2) improved quality, effective delivery, and use of clinical and other preventive services to address prevention and management of hypertension and diabetes; and 3) increased community clinical linkages to support prevention, self-management, and control of diabetes, hypertension, and obesity. These short-term outcomes lead to and are a response to the basic accomplishments.

The short-term outcomes lead to intermediate outcomes: 1) increased consumption of nutritious food and beverages and increased physical activity across the life span; 2) increased breastfeeding initiation, duration, and exclusivity; 3) improved medication adherence for adults with high blood pressure and adults with diabetes; 4) increased self-monitoring of high blood pressure tied to clinical support; and 5) increased use of diabetes self-management and primary prevention programs.

The intermediate outcomes lead to long-term outcomes: 1) improved prevention and control of hypertension; 2) improved prevention and control of diabetes; and 3) improved prevention and control of overweight and obesity.

Figure 1.
Program logic model for State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health program. Abbreviations: A_1c, glycated hemoglobin A_1c ; CVD, cardiovascular disease; DDT, Division of Diabetes Translation; DHDSP, Division for Heart Disease and Stroke Prevention; DNPAO, Division of Nutrition, Physical Activity, and Obesity; DPH, Division of Population Health, School Health Branch; DSME, diabetes self-management education; K–12, kindergarten through 12th grade.

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The evaluation approach to state public health actions is composed of 4 elements: national evaluation, evaluation technical assistance, performance measurement, and state evaluation. National evaluation consists of assessing progress across states, data aggregation, the national evaluation workgroup, and evaluation implementation. Evaluation technical assistance consists of capacity building, the evaluation technical assistance workgroup, and evaluation fidelity. Performance measurement consists of health outcomes and reach, the performance measure workgroup, and reporting guidance. State evaluation consists of program improvement, state evaluation plans, the state evaluation workgroup, and state evaluation reports.

Figure 2.
Components of state public health actions evaluation, State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health (State Public Health Actions).

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