GTE Toolkit

Getting to Equity in Obesity Prevention (GTE) Toolkit

Graphical Guide to Four Types of Complementary Considerations

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Quadrant 1: Analyzing and planning an approach

Quadrant 2
:
  Identifying circumstances or factors that might work against the effectiveness of the approach

Quadrant 3
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Finding ways to address relevant individual social needs

Quadrant 4
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Leveraging community assets, alliances, and health promotion resources to foster adoption and sustainability

The circle depicts guidance for working within four complementary domains (termed quadrants). The “wings” list examples of what each quadrant might involve.

Analyze and plan the potential PSE intervention (INCREASE HEALTHY OPTIONS)

What problem do you and your collaborators aim to solve?

  • State the problem you would like to solve
  • Review relevant intervention options
  • Consider characteristics of the intervention settings, e.g., health care setting or type of community setting?
  • Think through the intervention objective, conceptual pathway(s) for influencing the outcome, and resources and other requirements for effective implementation
  • Focus on your main pathway(s) for adoption and effects on outcomes but recognize that the change process will not occur from simple linear thinking (see later section on synergy)

Examples of questions to ask 

  • Does this intervention address the identified problem?
  • What data can you gather about the identified problem?
  • In what ways is the intervention relevant to this population and context?
  • How does this intervention work, that is, what is the primary pathway for the intervention effect?
  • What evidence suggests that this is a valid pathway in this context? Has it shown effectiveness in similar settings?
  • What assumptions are implicit or explicit? and how well are they met in this context? If not, what needs to be changed or added?
  • What contextual factors or other interventions might influence the effects of this intervention? Are those factors present in this context?

Tools and resources

  • See Appendices 6, 7, 8, 9, 10, and 11
  • County Health Rankings and Roadmaps https://www.countyhealthrankings.org/
  • Dupuis R et al. Use of Evidence-Based Interventions to Promote Healthy Weight, Nutrition, and Physical Activity in Community Health Improvement Plans from Large Local Health Departments. J Public Health Manag Pract. 2023
  • Fernandez et al:  Implementation mapping. Using intervention mapping to develop implementation strategies. Frontiers in Public Health 2019
  • Community Tool Box, Chapter 2 –  Developing a Logic Model or Theory of Change
Identify factors that might work against or detract from implementation or effectiveness (REDUCE DETERRENTS)
  • Refer to pathways and processes identified for the potential PSE intervention [Quadrant 1]
  • Review and elicit stakeholder knowledge and published evidence of factors and circumstances that are likely to interfere with these pathways and processes in the relevant context
  • Refer to “Barriers” in the CDC Practitioner’s Guide to Advancing Health Equity [Appendix 3]

Examples of questions to ask

  • Do eligibility restrictions or enrollment procedures pose barriers to implementation or participation (e.g., immigration status, place or length of residence, income)?
  • Do pervasive factors in the setting directly counteract program outcomes (e.g., heavy promotion of unhealthy foods and beverages or higher costs of healthy foods)?
  • Do personal safety issues discourage access or participation (e.g., location of food pantry or farmer’s market; criminal activity in a park or near recreation center)?
  • Is there a normative stigma associated with program participation? (e.g., negative perceptions of accepting food charity)
  • Are there concerns about current or past injustices, racial or ethnic discrimination, or profiling that discourage participation, e.g., potential mistreatment by police or in retail settings?)?
  • Have historic and present-day discrimination, harm or mistreatment created distrust of health care providers and the healthcare system?
Identify government, philanthropic, or private-sector programs to address individuals’ social and economic needs (IMPROVE SOCIAL AND ECONOMIC RESOURCES)

Examples of questions to ask


How can we extend individuals’ financial stability and resources through enrollment in …?

  • nutrition assistance programs
  • other income support programs
  • rent subsidy or other housing support programs
  • employment assistance programs
  • health insurance

How can we assist individuals in addressing life challenges that detract from their ability to meet their wellness goals, through …?

  • increasing computer or mobile access and skills
  • providing connections to legal services
  • increasing community investments that directly benefit individuals, e.g., employment opportunities
  • improving access to higher education, scholarships and job training opportunities

Tools and resources

  • “Social needs” are manifestations of the effects of various adverse social determinants of health. They refer to individual needs rather than community conditions. A focus on structures that lead to adverse social determinants of health is one aspects of Quadrant 4.
  • Addressing social needs is in the realm of human services and social work.  We recommend collaborating or partnering with researchers or practitioners in these fields.  To familiarize yourself with what might be available through public and non-profit sources review resources available through 211 (states) or 311 (local) that are widely available across the United States. 
Identify community-level assets and resources for addressing adverse social determinants of health and that support health and well being (BUILD ON COMMUNITY CAPACITY)

Examples of community strengths to look for

  • track record of community action initiatives
  • accessible and cooperative political leadership
  • community leaders
  • volunteer mobilization
  • partnerships and coalitions
  • local health and human services
  • leadership from faith communities and other local organizations
  • anchor organizations in the private sector
  • educational institutions
  • network of community-based organizations
  • leadership from directly impacted communities and those with lived experience
  • faith organizations
  • positive climate for small businesses
  • active civic engagement
  • public schools
  • healthcare settings and hospitals
  • transportation infrastructure
  • health promotion campaigns
  • community development corporations
  • shared identity, connectedness, and trust

Tools and resources