Form 1 Nutrition and Physical Activity Initiatives to Prevent O

Program Description Nomination Form Microsoft Word Version

Public reporting burden of this collection of information is estimated to average one hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN:  OMB 0920-XXXX

Nutrition and Physical Activity Initiatives

to Prevent Obesity

Nominations Requested! Submission Deadline: XX/XX/XXXX

Identification of effective strategies is critical to build the evidence base for community level obesity prevention, but rigorous evaluation and empirical research studies are costly and time-consuming. By conducting a pre-evaluation assessments, or evaluability assessments, it is possible to determine if an initiative is ready for a full-scale, rigorous evaluation and what potential barriers an evaluation study might need to address. Pre-evaluation assessments consist of a site visit to assess implementation, data availability, intended outcomes, and staff capacity, all of which allow for determining whether or not an initiative is ready for an intensive evaluation of effectiveness.

We need your help to identify promising initiatives!

The CDC Division of Nutrition, Physical Activity, and Obesity is looking for state and local-level initiatives that have been implemented with apparent notable success to improve nutrition and increase physical activity. We are especially interested in programs and policies that address low-income populations and ethnic groups that experience higher rates of obesity. Please note that all submissions are voluntary.

We are seeking nominations of initiatives that address the issue of obesity through improved nutrition and increased physical activity, but which have not already undergone a rigorous evaluation of effectiveness. An Expert Panel will select approximately ten initiatives for Pre-evaluation Assessments. Project staff will conduct site visits in the spring of 2012, and assessments will be made of the initiative’s implementation, data availability and outcomes. Based on the reports of these visits, the Expert Panel will identify initiatives that show promise in addressing the issue of obesity and readiness for rigorous evaluation. Some consultation will also be offered during the site visit by CDC project staff for improvement and evaluation design.

To share your notable initiative with us, visit http://www.zoomerang.com/Survey/WEB22CMCSHWU7W/ or complete the attached form and provide it to: Kari Cruz ([email protected], phone: 404-321-3211, fax: 404-321-3688).

To nominate an initiative for the Pre-Evaluation Assessment of Nutrition, Physical Activity, and Obesity Programs and Policies, please provide the following information to Kari Cruz:

[email protected]

Phone: 404-321-3211

Fax: 404-321-3688

Submission Deadline: XX/XX/XXXX

1. Name of Initiative:

     

2. Location of Initiative:

     

  

City State

3. Initiative Contact:

Name	     
Phone	     
Email	     
Website (if applicable)	     

4. Your Contact Information (if different from above):

Name	     
Phone	     
Email	     

5. What is the initiative (program, policy or environmental change) that is being implemented?

6. Initiative Description: The general description should entail: Who is involved in the initiative, what does the initiative do—what projects has it implemented/undertaken, when did they start, where is the initiative located and who funds the initiative(s).

7. What is the initiative’s current reach? Describe who the primary intended population is of your initiative; provide information about what percent would you say you ARE now reaching of this targeted population; note how you collect that information; discuss if applicable, how the initiative was designed to reach underserved groups or those disproportionately affected by obesity (specify which groups: low income, members of specific racial/ethnic groups).

8. What data are being collected for the initiative? This can include current or past data sources.

9. What outcomes of interest does the initiative address? Describe the short-term or longer-term outcomes that are being addressed by your initiative.

10. To what degree have stakeholders accepted the initiative? Describe how acceptable your initiative is to your immediate stakeholders (grassroots groups, government agencies, businesses/workplaces, etc…) and your target audience.

11. To what extent has this initiative been implemented as designed: Describe the degree to which your initiative has been implemented (I.e. What stage of implementation is your initiative at: are initiatives’ projects or policies being piloted, in early implementation or established).

12. How feasible would it be in other similar settings? Describe how easy would it be for others (e.g. community based organizations, Health Departments, etc…) to implement a similar initiative as yours in similar locations elsewhere in the U.S.

13. How transportable/generalizable is the initiative? Describe how easy would it be for others to implement a similar initaitive as yours in a setting that is very different from yours (e.g., if in an urban location, implementing in a rural setting); to implement a similar initiative as yours for another target population (e.g. if for a Hispanic population, implementing for an African American population, or if for a medium-income area, implementing for a low-income area); and whether you know if other states or communities adopted initiatives similar to yours.

14. How sustainable is the initiative? Describe whether it is dependent on special resources, involves a certain leader/champion within the community or organization, etc…

15. To what degree are health effects of the initiative sustainable? Discuss the likelihood that the health effects of this initiative are sustainable in the long term.

16. Does the organization or initiative appear to have the capacity to undergo an EA? As mentioned, an EA would involve a couple of evaluators conducting a site visit to your location to talk with directors of the initiative and learn more about how it is being carried out. The visit usually takes about 2 days, and the team talks with about 9 – 12 people while there and also provides a debrief to the initiative’s leadership on the last day. The site visitors would need a little help from the site in advance to schedule the interviews. Based on that description, would you say your organization and staff would be able to participate in a pre-evaluation assessment?

17. Finally, what characteristics would you say make this initiative a potentially promising practice?

0