Community Health Improvement Plans and Physical Activity Implementation Strategies: Findings from a Cross-Sectional Survey of US Local Health Departments
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Americans do not engage in enough physical activity (PA) to achieve health benefits. Community Health Improvement Plans (CHIPs) are tools that local health departments (LHDs) can use to strategically change PA levels. However, strategies to implement physical activity are understudied, making it challenging for public health practitioners to use them to their full potential. This study aimed to describe the PA implementation strategies that LHDs use within their CHIPs. An online survey was developed and distributed to 67 randomly chosen, accredited LHDs within the United States. Questions were asked about respondents’ CHIP physical activity goals and objectives, barriers to increasing physical activity, and types of chosen implementation strategies using their perceived beliefs. Responses were analyzed using both qualitative theming analysis and descriptive statistics. A majority of respondents reported that their CHIPs addressed PA (75%). Respondents reported that the PA implementation strategies used within their CHIPs were safe (mean=4.57, SD=0.75), but the belief that strategies would increase PA levels was low (mean=3.39, SD=1.12). Qualitatively, respondents most commonly reported PA objectives within the built environment/infrastructure theme (mean=5.16, SD=3.23). However, this was not reflected quantitatively when out of nine strategy categories, infrastructure changes were the least selected (39.3%, 1≥ strategy selected). PA is a commonly reported priority area among LHD’s CHIPs, with a majority implementing well-studied, evidence-based strategies. However, there are inconsistencies between described health outcomes and the chosen implementation strategies to achieve them. This indicates a need to make implementation strategy terminology and components more consistent and to encourage a comprehensive collection of implementation strategies that is accessible to LHDs. This also calls for more research into the design and administration of CHIPs to encourage an increase in PA by selecting appropriate strategies, and to increase LHD’s understanding of implementation strategies.