Public Health

Several staff members have particular interest and background in public health issues, such as childhood obesity, fitness, and nutrition.  Our projects in this area have included evaluation of a health clinic in a public school, evaluation of a mental health program for students, and work on developing a Theory of Change for health in California.  Our Theory of Change work has involved two smoking cessation initiatives, one for the American Legacy Foundation, and a large project, which is described below, with the Robert Wood Johnson Foundation involving Theory of Change and evaluation.

Nationwide Smoking Cessation Evaluation

A joint ActKnowledge-Center for Human Environments team headed by Andrea Anderson-Hamilton has been awarded a two-year grant by the Robert Wood Johnson Foundation, beginning April 2009, to evaluate the Foundation’s Tobacco Policy Change (TPC) program. The TPC program combines advocacy, communications, and community collaborations to engender policy change and programming in support of effective tobacco prevention and cessation at state, regional, local and tribal levels, with particular emphasis on vulnerable populations. TPC seeks to demonstrate convincing evidence of which advocacy strategies work, in which contexts and why, to further the cause of tobacco prevention and control policy. The evaluation will focus on outcomes of the efforts across multiple sites, also on the effectiveness of coalitions in influencing tobacco policy.

ActKnowledge will create a Theory of Change for the Tobacco Policy Change Program as the framework for learning and evaluation across the entire scope of the project. The Theory of Change will reflect insights from existing models of tobacco advocacy, Robert Wood Johnson Foundation’s experiences with tobacco policy advocacy, and the empirical findings from evaluations of other tobacco policy change efforts. The Theory of Change will model key policy change pathways, stakeholder assumptions about the political and social contexts necessary to policy change, the organizational outcomes coalitions need to successfully influence tobacco policy, and the resources needed to produce the desired outcomes.

The evaluation research seeks to answer:

• which Tobacco Policy Change program grantees created policy change,
• how and why those groups were able to move the policy needle;
• which environmental factors factored into the success,
• how the Foundation itself—through the structure of the TPC program, its technical assistance and program requirements—supported the success of each alliance; and
• whether the composition and capacity of the coalitions themselves had an impact on success.

A set of cross-site research questions concern which approaches were effective in promoting changes in minority communities, and how the national Tobacco Policy Change Theory of Change was adapted to reflect the particular needs of Native American, African American and Latino communities.
Research methods will include online surveys, key-informant interviews, archival analysis, and case studies of certain sites. The evaluation promises to inform future funding and program development decisions, provide lessons learned and best practices to the field, and add to the literature on mixed-method advocacy evaluation in public health, specifically tobacco prevention and cessation.

Public Health Theory of Change in California

The California Endowment, a private health foundation, focuses on grant making, advocacy, and policy in the areas of health care access, culturally competent health systems, and the elimination of health disparities among sectors of the population. ActKnowledge worked with Endowment staff to develop a theory of change for the Endowment's three major goal areas.  The theory set forth the necessary long-term outcomes for Californians, such as healthy communities and a responsive health system.  Instrumental outcomes on the pathway concerned lasting improvements in policy and systems change, vibrant and engaged civic organizations and community leaders, public awareness, public will, and civic engagement.  The theory identified outcomes for the Endowment in creating new health care access models and in supporting community-driven changes to health policy and systems, what the California Endowment calls its "grassroots to treetops" approach to health.