Objectives: This manuscript describes policy, systems, and environment (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 PSE changes occurring over a one-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 one 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 was noted for 99.2% of the scores with a total of 13 PSE changes documented across the sites. The greatest change was noted related to leadership, indicating increased commitment by site leadership to support health.


This is the accepted manuscript of Simpson, V. Creating healthier policies, systems, and environments: Using the CDC CHANGE tool to evaluate the impact of a coalition provided community-based wellness program. Public Health Nurs. 2020; 37: 510– 516. https://doi.org/10.1111/phn.12748


Health care coalitions, minority health, rural health, policy, systems, and environment, health promotion

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