Identifying Synergistic Mechanisms of Community-Led Policy, Systems, and Environmental Change for Childhood Obesity Prevention in the Multi-Site Catalyzing Communities Initiative

Abstract

This evaluation reports how the Catalyzing Communities Initiative, a whole-of-community, multi-site intervention, supported equity-focused policy, systems, and environmental (PSE) changes to prevent childhood obesity in three U.S. communities from 2023 to 2024. We conducted a mixed-methods evaluation using survey data from 35 committee members (multisector representatives selected by local health-promotion leaders) and interviews with 29 committee members across three communities. We used a three-framework analytic approach: the Getting to Equity Framework was used to classify PSE changes, the Consolidated Framework for Implementation Research guided analysis of contextual influences, and Ripple Effects Mapping, a systems science method, identified how PSE-related actions created chains of perceived impacts over time. Committee members reported a total of 339 PSE impacts, defined as perceived changes attributed to specific PSE-related actions, such as shifts in partnerships, practices, or community conditions. The majority of impacts fell within Getting to Equity Quadrants 4 (increasing community capacity and opportunity) and 1 (increasing healthy options). Systems thinking tools that were used by committee members as part of the Catalyzing Communities Initiative were noted to enhance cross-sector coordination. Ripple effect maps revealed reinforcing loops, such as systems-informed community action and community mobilization, that enhanced cross-sector collaboration and contributed to synergistic change. Implementation facilitators of change included strong leadership and supportive policy environments, while key barriers included affordability, stigma, and exposure to community violence. Findings illustrate how integrating equity frameworks, implementation science, and Ripple Effects Mapping can reveal mechanisms through which local actions promote equity-oriented change.

Keywords: Catalyzing Communities; Childhood obesity; Community development; Community engagement; Getting to Equity Framework; Implementation; Policy, Systems, and Environmental Change; Prevention.