title: Process evaluation of a regional public health model to reduce chronic disease through policy and systems changes, Washington State, 2010-2014.
abstract: BACKGROUND
  Although the regionalization of public health systems has been well documented in the case of emergency preparedness, there is little literature on the application of regional approaches to other aspects of public health. From 2011 through 2014 the Washington State Department of Health implemented a Community Transformation Grant to support community-level policy and systems changes to decrease chronic disease risk factors and increase access to clinical preventive services. The Department of Health implemented the grant through a regional model, grouping 32 of the state's 35 local health jurisdictions into 5 regions. Our process evaluation identifies the challenges and facilitators to Community Transformation Grant planning and implementation.
  
  
  METHODS
  We conducted 34 key informant interviews with people directly involved in the implementation of the Community Transformation Grant. We interviewed state and local partners, including representatives from each region, the Department of Health, external consultants, and regional partners. We collected data from October 2013 through July 2014.
  
  
  RESULTS
  Challenges for planning, building, and implementing a regional model for chronic disease prevention included stakeholder buy-in, regional geography, and communication; facilitators included shared regional history and infrastructure, strong leadership, collaborative relationships, shared vision and goals, sufficient funding, and direct technical assistance and training.
  
  
  CONCLUSIONS
  Lessons learned in Washington State provide a foundation for other states interested in using a regional approach to reduce chronic disease risk. Policy and systems changes require adequate time, funding, and staffing. States and funders should work closely with local leaders to address these challenges and facilitators.
authors: University of Washington, Seattle, Washington.
authors: Lina P
authors: LP
authors: Walkinshaw
authors: Health Promotion Research Center, University of Washington, Department of Health Services, 1107 NE 45th St, Ste 200, Seattle, WA 98105. Email: cemason@uw.edu.
authors: Caitlin
authors: C
authors: Mason
authors: University of Washington, Seattle, Washington.
authors: Claire L
authors: CL
authors: Allen
authors: University of Washington, Seattle, Washington.
authors: Thuy
authors: T
authors: Vu
authors: Washington State Department of Health, Olympia, Washington.
authors: Paj
authors: P
authors: Nandi
authors: Washington State Department of Health, Olympia, Washington.
authors: Patti Migliore
authors: PM
authors: Santiago
authors: University of Washington, Seattle, Washington.
authors: Peggy A
authors: PA
authors: Hannon
mesh_terms: D002908:Chronic Disease / Q000517:prevention & control*; D003153:Community Health Services / Q000191:economics / Q000592:standards; D003253:Consultants / Q000523:psychology; D017046:Cost Savings; D005260:Female; D005381:Financing, Organized; D006284:Health Plan Implementation; D006291:Health Policy; D006292:Health Priorities; D006801:Humans; D033183:Interdisciplinary Communication; D007373:Interinstitutional Relations; D007407:Interviews as Topic; D009111:Local Government; D008297:Male; D009936:Organizational Innovation; D017064:Process Assessment, Health Care / Q000379:methods*; D011634:Public Health / Q000379:methods / Q000592:standards; D011635:Public Health Administration / Q000331:legislation & jurisprudence; D036301:Qualitative Research; D012040:Regional Health Planning / Q000639:trends*; D013219:State Government; D014861:Washington; D000078329:Workforce