Objectives: This manuscript describes policy, systems, and environments (PSE) changes made to support health secondary to a county-based coalition nurse-led program targeting vulnerable populations at five community-based sites in a single rural Midwest county.
Design: A mixed-methods pre-post approach was used to evaluate the PSE changes occurring over a 1-year period secondary to wellness programming.
Sample: Five community sites including three predominantly manufacturing worksites and two faith-based sites were included in this study.
Measurements: The Centers for Disease Control and Prevention Community Health Assessment aNd Group Evaluation tool was used to collect PSE data both at site initiation and 1 year later. Logs kept by program staff which included discussions with site leaders and program participants were also used to measure PSE changes.
Intervention: Monthly wellness programming which included intentional feedback to site leadership concerning participant feedback and coalition staff observations of the impact of site specific PSEs on healthy lifestyle behaviors.
Outcomes: Positive changes reflecting improvement in policy and environments were noted for 99.2% of the scores with a total of 13 PSE changes documented across the sites. The greatest change noted related to leadership, indicating increased commitment by site leadership to support health.
Keywords: and environment; health care coalitions; health promotion; minority health; policy; rural health; systems.
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