https://orcid.org/0000-0002-7874-0813
Figures
Abstract
Purpose and objectives
This study evaluated progress toward policy, systems, and environmental (PSE) changes through community-led actions supported by the Catalyzing Communities initiative, guided by Stakeholder-Driven Community Diffusion (SDCD) theory. Objectives included assessing community action implementation, evaluating SDCD-informed strategies’ role in enhancing capacity, and identifying contextual factors influencing progress towards PSE changes.
Intervention approach
Catalyzing Communities engaged 23 key partners across eight U.S. communities. These partners led committees of 110 local champions and integrated local insights and resources into community-led actions. Capacity-building strategies supported action prioritization and implementation.
Evaluation methods
A mixed-methods approach included web surveys and follow-up interviews. Surveys assessed action implementation, while interviews explored impacts and contextual factors. Data were analyzed using thematic analysis, supported by an iteratively developed codebook and double coding.
Results
Fourteen changemakers completed surveys and ten participated in interviews. They led 82 local champions across six communities in prioritizing and implementing 21 community-informed actions. Actions differed across communities based on local priorities, including enhancing early childhood and school programs, improving food access, promoting active living, and fostering community connections. Most actions were ongoing, in progress at the time of data collection, and partially successful in reaching target populations. Capacity-building strategies – such as peer networking, tools like causal loop diagrams, and technical assistance – were critical for building relationships, enhancing systems thinking, and securing funding. Contextual factors, including committee synergy, readiness, organizational capacity, and the impact of COVID-19, shaped progress toward PSE changes.
Citation: Moore TR, Chusan YAC, Sanderson E, Calancie L, Hennessy E, Appel JM, et al. (2025) Community-led change: Progress toward policy, systems, and environmental impacts through the Catalyzing Communities initiative. PLoS One 20(11): e0336482. https://doi.org/10.1371/journal.pone.0336482
Editor: Alon Harris, Icahn School of Medicine at Mount Sinai, UNITED STATES OF AMERICA
Received: April 12, 2025; Accepted: October 27, 2025; Published: November 10, 2025
Copyright: © 2025 Moore et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Data can be found via the OSF repository by following this link: https://osf.io/fhk94/files/osfstorage.
Funding: CDE received funding for this research from the JPB Foundation under Grant Agreement GR-2020-2503. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Community-based interventions continue to be a cornerstone in public health for addressing the complex, multifaceted determinants of health that contribute to disparities across populations [1]. These interventions, which often focus on creating Policy, Systems, and Environmental (PSE) changes, are increasingly recognized as essential for achieving sustainable health improvements at the community level and advancing health equity [2]. The concept of PSE change is grounded in the recognition that individual behavior is significantly influenced by the broader context in which people live, work, and play [3]. Further, interventions that modify the environment to make healthy choices the default option tend to be more sustainable and reach a broader audience than those focused solely on individual behavior change [4]. This approach aligns with socioecological models of health behavior, which propose that multiple levels of influence, including interpersonal, organizational, community, and policy levels, should be considered in the design of public health interventions [5].
The importance of building community capacity as a strategy for promoting PSE changes is well-documented in the literature [6,7]. Community capacity refers to the ability of community members to effectively identify problems, mobilize resources, and implement strategies to improve health outcomes [8]. Research has shown that capacity-building interventions can lead to significant improvements in community health by fostering local ownership, enhancing social capital, and facilitating the sustainability of health initiatives [9]. Moreover, the involvement of community partners in the design and implementation of interventions has been shown to increase the relevance, acceptability, and effectiveness of these efforts [10].
Despite the potential benefits of community-based interventions, their success is often contingent on a range of contextual factors that can either facilitate or impede progress. These factors include the availability of resources, the organizational capacity of local institutions, and the broader economic or political conditions within the community. Additionally, the COVID-19 pandemic has introduced unprecedented challenges for many communities, exacerbating existing inequalities and disrupting traditional modes of social interaction and service delivery. However, the pandemic has also provided opportunities for innovation and has highlighted the importance of addressing systemic inequities through PSE changes [11].
The Catalyzing Communities initiative is designed to enhance capacity for community-led PSE change. Catalyzing Communities convenes community partners, including key community leaders (hereafter, changemakers) and committees of local champions from various sectors that influence child health in communities across the US. Changemakers refer to designated community leaders who co-led the initiative and provided data for this study, committee members (or local champions) refer to individuals who collaborated in developing and implementing community-led actions (CLAs), and community partners is used as a general term to encompass both groups. Through group model building (GMB), a participatory and community-driven approach to engage communities in eliciting and sharing information about complex systems related to child health [12], committee members, often supported by a backbone organization and led by changemakers, seek to understand and address systemic drivers and impacts of child health, prompting to the prioritization of CLAs towards PSE changes. Changemakers play a dual role as both leaders of committee efforts and strategic partners in the research process. They provide ongoing feedback on committee dynamics, successes, challenges, and needs, ensuring that community perspectives shape the development and implementation of CLAs.
Purpose and objectives
The purpose of this study is to evaluate the progress towards PSE changes through CLAs and capacity-building strategies that were supported by the Catalyzing Communities initiative, informed by the Stakeholder-Driven Community Diffusion (SDCD) framework. This study aims to address the following research questions: From the perspective of community changemakers, (1) to what extent have communities implemented their CLAs?; (2) how have SDCD-informed strategies contributed to progress toward PSE changes?; (3) what contextual factors have influenced progress toward PSE changes?
To explore these questions, we utilized an explanatory sequential mixed methods approach [13]. This approach involved collecting and analyzing quantitative survey data first, followed by qualitative interviews to provide deeper insights and context, helping to validate and elaborate on the survey findings.
Intervention approach
Catalyzing Communities is rooted in the SDCD framework, which seeks to promote sustainable PSE changes by uplifting local knowledge and leveraging resources to address systemic issues, ultimately aiming to improve community well-being. The SDCD-informed process (Fig 1) includes convening a multi-sector committee to understand the drivers of a chronic disease trend overtime through group model building sessions (GMB), developing action plans with funding support, implementing and evaluating CLAs, and ensuring sustainability through impact measurement and continued funding efforts [14].
The SDCD theoretical framework includes five main strategies that build on the capacity of community partners, including changemakers and committee members, for community-led PSE change: training (including systems-thinking training such as GMB), peer networking opportunities to foster collaboration, technical assistance (TA), tools (e.g., causal-loop diagrams, communication materials), and seed funding for tacking action and incentives. Progress toward PSE changes from capacity-building strategies follows two potential pathways (Fig 2). In the first, SDCD strategies directly trigger community actions, leading to targeted, community-led interventions that address specific local needs and advance PSE changes. In the second pathway, SDCD strategies enhance key capacities—such as knowledge, engagement, systems thinking, social connections, and information diffusion—often conceptualized as coalition capacities [15]. This enhanced capacity strengthens the committee’s ability to support and sustain PSE changes in their communities. This paper analyzes how changemakers view progress toward PSE changes stemming from the Catalyzing Communities initiative. We evaluate the extent to which communities have implemented their prioritized CLAs, the influence of Catalyzing Communities strategies on PSE changes, and the contextual factors within organizations, committees, and communities that altered progress. The findings contribute to the evidence base on community-based interventions, highlighting the need for adaptive, context-sensitive, systems-driven approaches in public health, particularly in light of evolving challenges like the COVID-19 pandemic.
Progress toward policy, systems, and environmental (PSE) changes from capacity-building strategies follows two potential pathways: 1) Strategies informed by the Stakeholder-Driven Community Diffusion (SDCD) theory directly trigger community actions, leading to targeted, community-led interventions that address specific local needs and advance PSE changes; 2) SDCD-informed strategies enhance key community capacities – such as knowledge, engagement, systems thinking, social connections, and information diffusion.
Methods
Sample
Catalyzing Communities partnered with key changemakers in eight U.S. communities across two cycles. The first cycle (2018-present) included Cuyahoga County, OH; East Boston, MA; Greenville, SC; Tucson, AZ; and Milwaukee, WI (first cohort/C1 communities). The second cycle (2023-present) involved Worcester, MA; East Aldine, TX; and Garfield Park, Chicago, IL (second cohort/C2 communities). Community changemakers co-lead the project, offering strategic guidance and ensuring that local needs, insights, and resources are integrated into CLAs. Changemakers were recruited via email for a web-based 15-minute survey and 60-minute follow-up interviews from a sampling frame of 23 changemakers across the eight communities. All participants provided written, informed consent after receiving a detailed explanation of the study’s purpose, procedures, and confidentiality protections. Participation was voluntary, and participants were informed that they could decline or withdraw from the study at any time without penalty. The study was approved by the Social, Behavioral, and Educational Research IRB. Data were accessed for research purposes on October 2, 2023, and interviews were conducted during the recruitment period from 10/02/2023–2/01/2024. The authors had access to information that could identify individual participants during and after data collection.
Surveys and interviews
Surveys, pre-populated with community-specific information, asked changemakers from each study site to list actions they know of that were taken in their communities due to their participation in the project and provided an overview of current initiatives (S1 File: Survey Questions). The survey concluded with a description of potential interview questions. Each individual or group interview included one to three changemakers. Interviews, conducted by a team of five experienced researchers spread across six interviews (S2 File: Interviewers), lasted about 60 minutes each and were audio recorded with participants’ consent. The interview protocol included questions on relationships formed, contextual factors influencing progress, changes in work approach, equity promotion, indicators of progress, funding opportunities, and dissemination products (S3 File: Interview Protocol).
Data analysis
Intensity scores for each PSE change action were calculated from survey responses, capturing four dimensions: impact, completion, duration, and reach, each rated as low, medium, or high, with scores ranging from 1 to 3. Impact levels were categorized as minimal, moderate, or significant; completion from not started to completed; duration from one-time events to ongoing; and reach based on target population engagement (from 0–5% to >20%). Adapted from the Healthy Communities Study [16], this scoring method provided a summary of each community action’s characteristics and effectiveness.
Following an explanatory sequential mixed methods approach, quantitative findings were further explored through interviews to clarify and update survey responses as needed. Thematic analysis guided qualitative analysis, with a codebook (S4 File: Codebook) developed iteratively through inductive and deductive approaches, incorporating frameworks like the Evidence-Based System of Innovation Support (EBSIS) by Leeman et al. (2015), Implementation Systems Framework by Wandersman and colleagues (2008), SDCD model, and the socioecological model [17,18]. Coding involved two trained student coders using Dedoose software, ensuring intercoder reliability (Cohen’s Kappa κ = .71) and resolving discrepancies through discussion. Code frequency and co-occurrence tables helped analyze popular themes and connections, and new themes were integrated into the evolving codebook through iterative refinement.
Results
Fourteen changemakers completed the online survey, and ten participated in online interviews across six communities: Greenville, SC; Tucson, AZ; and Milwaukee, WI; Worcester, MA; East Aldine, TX; and Garfield Park, Chicago, IL, thereby reflecting the perspectives of 82 community leaders across diverse communities in the US. While we do not report changemakers’ demographics due to easy identification, Table 1 reports characteristics of the six committees, which were led by 19 changemakers, and the six US communities they represented. Findings are organized into quantitative and qualitative results, drawing from surveys and interviews, respectively.
Findings on the extent to which communities implemented their prioritized actions and the resulting impacts on PSE changes are based on survey data, which are contextualized with illustrative quotes from the interviews. Interview data further highlights the CLAs derived from the Catalyzing Communities initiative and the SDCD-informed strategies that supported these CLAs, along with the contextual factors that either facilitated or hindered progress toward PSE changes.
Community actions: types, extent of implementation, and impacts
Table 2 reports quantitative findings, which includes descriptions of: (a) types of CLAs; (b) the extent of CLAs implementation: duration, completion, and reach, considering the time communities had for their implementation; and (c) ratings of CLAs’ impacts and intensity of effectiveness towards PSE changes. Across all communities, changemakers listed 21 CLAs and rated the extent of their implementation.
The types of actions were diverse and tailored to the specific priorities of each community. For instance, in one community that focused on food security, partners developed educational materials to support other key community actors (i.e., food security coalition members). In another community committee that was focused on promoting health among children and their families, partners organized community baby showers to build a sense of community and connect families to resources with a goal of addressing high maternal and infant morbidity rates among Black residents.
The extent of community actions captures the breadth and depth of efforts by community partners in implementing various actions to address their local priorities. It assesses how these actions are planned, executed, and reach their intended audiences, offering a comprehensive view of community engagement. The description of the extent of community actions includes Community actions’ duration, level of completion, and reach. In making sense of differences of extent of implementation of actions across communities, we examined the time that each community had to implement their actions. C1 communities had approximately three years between action prioritization and survey completion, whereas C2 communities had less than one year. This difference influenced the extent and depth of the actions undertaken, affecting their overall implementation levels.
Community actions: Duration. This category refers to whether an action was a one-time event, multi-day/multi-year effort, or ongoing initiative. Understanding duration was key to assessing the sustainability and impact of these actions. One-time events can lay the groundwork for future efforts, while ongoing initiatives enable continuous community engagement and iterative improvements.
More than half of the community actions (13 out of 21) were ongoing, such as recurring events or integrating support into existing practices. Multi-day or multi-year actions (4 out of 21) were more common in C1 communities, where additional time since action prioritization facilitated repeated implementation and adjustments. One-time actions (4 out of 21) included financial support to committee members (in addition to participation stipends) or specific outreach events, such as presentations to disseminate information about the committee’s work and were more common in C2 communities due to lesser time for repeated actions.
Community actions: Level of completion. This category measures the progress of community actions, from not started or planning, to in progress, or completed. It reflects how far communities have advanced in implementing their prioritized actions, contributing to PSE changes.
Of the 21 community actions, 14 were in progress at the time of data collection and 7 had been completed. All but one of the completed actions occurred in C1 communities.
Community actions: Reach. Reach measures how successfully community actions engaged their intended target populations, classified as not yet successful, partially or highly successful. The target populations included community residents and individuals in institutions or coalitions.
Most community actions (11 out of 21) were partially successful, respondents self-reported that they reached 5%–20% of the intended population. Six actions had not yet reached their intended population (<5%), often due to the limited time since implementation or dependence on completing initial phases. Only one C1 community had three actions that were highly successful, reaching over 20% of the target population.
Table 3 highlights representative quotes from changemakers that illustrate the extent of CLA implementation, organized by duration, completion, and reach. These quotations contextualize the quantitative findings reported in Table 2.
In addition to the extent of implementation of community actions, changemakers reported the perceived impact of their CLAs on PSE changes within the framework of the SDCD theory-informed intervention strategies. The progress towards PSE changes is categorized into Community actions’impacts, and intensity of community actions.
Community actions: Impacts. This category describes the extent to which CLAs influenced PSE changes. Of the 21 actions, 12 were perceived by changemakers to have a moderate influence, mainly by enhancing skills and services that support PSE progress, such as connecting sectors or sharing resources to improve child health. These actions often aimed to strengthen organizational practices or alter the physical environment in ways that support healthier communities. Significant influence was attributed to 6 actions, which increased access or reduced barriers to PSE changes. Examples include forming a subcommittee on racial equity, establishing a health equity board, and securing grants for future initiatives. These actions were seen as pivotal in advancing community goals and addressing systemic challenges. One community, with the shortest partnership duration (7 months), reported minimal PSE influence for three actions, as they were still in the planning phase. Table 4 presents illustrative quotes describing changemakers’ perceptions of the impact of CLAs on policy, systems, and environmental outcomes.
Intensity of community actions. Intensity scores (Table 2) were calculated based on the extent of implementation of community actions and resulting impacts. The average intensity score or effectiveness towards PSE changes for all community actions was medium (2.20) though differences were found across communities from the two cohorts. Among C1 communities, the intensity score ranged from medium to high (2.25–3.00), and in C2 communities the intensity score ranged from low to medium (1.25–2.50). The CLA with the highest intensity score was the formation of a committee focused on racial equity, characterized as a highly impactful and ongoing activity that was completed by the time of survey completion. The CLAwith the lowest intensity score was a one-time provision of financial support to foster participation among committee members; although this CLAwas already in progress, it was partially successful in reaching committee members by the time of survey completion and it was perceived as having minimal impact.
Supporting PSE progress through SDCD strategies
CLAs that stemmed from the Catalyzing Communities initiative contributed to PSE change by generating tangible impacts and fostering key SDCD-specific constructs. Across all communities, applying for or securing additional funding was the most frequently mentioned impact (32 mentions), followed by the development of communication materials (31 mentions). Less commonly cited impacts included an increased focus on social justice (24 mentions) and community empowerment (22 mentions), while policy-specific progress was rarely discussed (5 mentions). The most frequently highlighted SDCD constructs were the development of new social connections (67 times), increased engagement (60 mentions), and enhancement of systems thinking (35 mentions).
While all Catalyzing Community strategies may have played a role in the progress towards PSE changes, and some strategies might be more relevant than others depending on the community, three of these strategies (peer networking, tools, and TA) emerged as the most frequently linked with SDCD Constructs or Impacts. Peer networking emerged as a key contributor to impacts across all communities (67 mentions), followed by the tools used in Catalyzing Communities such as the development and use of causal loop diagrams (40 mentions), and TA from the research team (28 mentions).
Table 5 summarizes co-occurrences between the three most frequently referenced SDCD capacity-building strategies (peer networking, tools, and TA) and the SDCD constructs or impacts they were perceived to be associated with. This table quantifies qualitative linkages identified through thematic analysis. For example, Peer networking was mentioned 67 times across all communities, and it co-occurred with New social connections 44 times, indicating that peer networking strategies may have an influence on establishing new social connections.
Considering the most frequent co-occurrences, this theme is organized into three categories that showcase the role of key SDCD Capacity-Building Strategies in promoting community impact: Peer networking and social connections, tools and systems thinking, and technical assistance and funding.
Peer networking and social connections. Peer networking primarily fostered “social connections” (44 co-occurrences), a key SDCD construct, by creating new or strengthening existing relationships that provided social support, information exchange, and a sense of community. Activities like convening regular committee meetings and Learning Collaboratives were instrumental in building these connections. Learning Collaboratives, which were led by the research team with input from a sub-group of community changemakers, brought community partners together monthly and played a crucial role in sustaining the SDCD intervention by facilitating shared learning and collaboration on community priorities.
Tools and systems thinking. Tools (e.g., practical communication resources, systems maps, frameworks) were closely associated with the construct of “systems thinking” (12 co-occurrences). Digital collaboration platforms like MURAL and visual tools like causal loop diagrams helped partners visualize complex systems and understand interconnections within their communities. For example, building causal loop diagrams in MURAL allowed partners to see how different factors interacted, supporting decision-making.
Technical assistance and funding. TA was linked with applying or securing additional funding (9 co-occurrences). TA, led by the research team with support from community-based system dynamics consultants, included activities, like facilitating meetings, reviewing evidence, and providing feedback on action implementation. TA was particularly instrumental in guiding partners through the process of seeking grants, which directly impacted their ability to continue and expand their initiatives.
Table 6 presents quotes that illustrate the link between SDCD capacity-building strategies and community impacts, providing insights into how these strategies contribute to progress toward PSE changes.
Fig 2 provides a concise visual summary of how SDCD capacity-building strategies connect to community-level impacts, complementing the detailed qualitative findings presented in Tables 5 and 6.
Contextual factors alter PSE progress
External influences on community progress toward implementing community actions or PSE changes included interpersonal dynamics (13 mentions), organizational factors within changemakers’ own institutions or their partner organizations (4 mentions), and the COVID-19 pandemic (4 mentions). Based on these findings, contextual factors were grouped into three categories: Committee synergy and readiness, institutional infrastructure, and impact of COVID-19.
Committee synergy and readiness. Pre-existing connections and diverse perspectives among community partners facilitated action development but sometimes hindered alignment on priorities. In one community, it was described how some committee members were used to doing downstream service work, like addressing food security through more food pantries and food box distribution, whereas after working together it was clearer the importance of addressing upstream factors like housing, transportation, childcare, loan forgiveness. Maintaining engagement of the full committee in the intervention was also difficult in some communities, potentially hindering progress.
Organizational policies and infrastructure. Limited funding and staffing affected communities’ ability to implement and sustain actions. Catalyzing Communities provided TA for grant applications, but backbone organizations’ fiscal reliance and staffing shortages hindered progress, even with TA support.
Impact of COVID-19. The pandemic disrupted committee activities and limited relationship-building opportunities. However, COVID-19 also highlighted systemic issues and some communities intensified their focus on health disparities, accelerating efforts toward PSE changes.
Table 7 presents illustrative quotes that offer insight into the contextual factors at the interpersonal, institutional, and macro levels, which influenced the trajectory of community actions and, subsequently, progress toward PSE changes.
Discussion
Advancing understanding of community-led PSE changes
Community-based interventions targeting PSE changes are essential for addressing social determinants of health and advancing health equity [19]. Although generally effective, research has lacked insights into the mechanisms of community capacity building and their role in sustaining PSE changes. Catalyzing Communities, and the SDCD-informed intervention used in it, addresses this gap by enhancing community capacity and establishing a structured approach to foster lasting PSE changes. This study demonstrates how community-based, SDCD-informed strategies such as peer networking, technical assistance, and systems-thinking tools can build community capacity and advance PSE changes. We identified clear patterns linking community engagement strategies with tangible outcomes in relationship-building, resource mobilization, and sustainability, by combining mixed-methods data across six communities.
While the Catalyzing Communities initiative demonstrated promising progress toward PSE changes, several challenges emerged that helped contextualize these findings. Many CLAs were still in early or mid-implementation stages, and several had only partially reached their intended populations by the time of data collection. These patterns reflect both the ambitious nature of PSE work and the short implementation window available for some communities, particularly those in Cohort 2. Additionally, the COVID-19 pandemic disrupted coalition meetings, strained organizational capacity, and limited opportunities for in-person relationship-building—factors that changemakers identified as slowing progress. Recognizing these challenges provides a more balanced view of community trajectories and underscores the importance of sustained support, flexible timelines, and adaptive strategies to translate early systems and environmental gains into longer-term policy change.
Extending the existing literature
The Catalyzing Communities initiative extends previous research by empirically demonstrating key capacities (e.g., social connections and systems thinking), strategies, and CLAs that may support effective PSE change. Drawing from Leeman et al.’s (2015) adapted EBSIS framework, and other frameworks, this study demonstrates how the SDCD framework can facilitate the practical application of these capacities and strategies, as well as support CLAs, across diverse communities with different socio-political and economic contexts, highlighting factors that influence the sustainability of community-based interventions [17].
Mechanisms of change and adaptation
A key contribution of this study is its detailed exploration of the potential mechanisms through which strategies and CLAs lead to PSE changes. While previous research has identified the importance of coalition-building and stakeholder engagement [20], this study goes further by mapping out the specific pathways through which these mechanisms may operate. For example, the study highlights how, from the perspective of community changemakers, peer networking strategies strengthen engagement with other community partners and with important child health equity topics and research, ultimately leading to making progress toward PSE changes. Further, mentions of peer networking co-occurred with impacts in policy, community empowerment, and self-efficacy. This focus on the ‘how’ of community capacity-building and impacts provides insights into the processes that underpin successful community interventions.
Additionally, the study’s adaptability in the face of the COVID-19 pandemic underscores its novelty. While the pandemic posed significant barriers to traditional methods of community engagement, the initiative adapted by leveraging digital tools and remote collaboration strategies. This pivot not only ensured the continuation of the project but also highlighted the resilience of the SDCD model and its applicability in crisis contexts. This aspect of the study adds a new dimension to the literature, illustrating how community-based interventions can remain effective even under unprecedented challenges [21].
Addressing gaps in the literature: community decision-maker perspectives
This study uniquely contributes to the literature by focusing on the perspectives of community changemakers as decision-makers in assessing the progress and impact of PSE changes. While much of the existing literature centers on community member or interventionist perspectives, this study provides valuable insights into how research community partners/changemakers perceive the effectiveness and sustainability of PSE changes. This perspective is crucial, as it highlights the alignment (or misalignment) between community priorities and the strategic objectives of health interventions [22]. Understanding this dynamic is essential for designing more effective community-based interventions that can gain support from both grassroots participants and leadership.
Limitations
While the Catalyzing Communities initiative sought to advance PSE changes, few direct local- or state-level policy impacts were observed during the study period. This finding likely reflects several intersecting factors operating within complex policy processes. First, policy change often requires extended timelines beyond the scope of our data collection, particularly for communities that had less than one year of implementation (Cohort 2). Second, partners often prioritized actions that could produce visible systems or environmental outcomes (such as new partnerships, improved coordination, or expanded programs) before pursuing formal policy reform. Third, many changemakers operated within organizational or municipal contexts where decision-making authority was distributed or constrained, limiting their ability to directly influence formal policy shifts at local or state levels. Nevertheless, there was some qualitative evidence of organizational-level policy changes in one community (Table 4, Community 2, C1). These findings align with prior research indicating that governance structures and competing local priorities can delay the translation of systems-level insights into formal policy outputs [23]. Future evaluations should continue to track whether early capacity-building and systems changes eventually lead to sustained policy outcomes at various governance levels over time.
Although this study involved diverse communities across the United States, the number of changemakers who completed surveys (n = 14) and interviews (n = 10) was relatively small, reflecting the intentional design of the Catalyzing Communities initiative to engage a select group of community leaders in depth. As such, the findings are not intended to be statistically generalizable but instead offer rich, contextually grounded insights into how community-driven processes unfold within different contexts. The emphasis on depth rather than breadth strengthens the transferability of findings to other multi-sector, systems-oriented community initiatives that share similar structures and goals. Future research with larger samples, including committee members and broader stakeholders, could further validate and extend these findings.
The findings rely primarily on self-reported data from changemakers, which may introduce subjectivity or recall bias. Although these reports provide valuable, insider perspectives on community and implementation processes, future research could strengthen validity by incorporating complementary data sources (e.g., independent policy or program audits, network analyses, or quantitative tracking of PSE outcomes) to triangulate and extend these findings.
Practical implications and future research directions
The findings from the Catalyzing Communities initiative have several implications for public health practice. The project potentially provides a scalable framework that can be adapted to other communities seeking to implement PSE changes by illustrating structured capacity-building and strategic engagement models that emphasizes systems thinking [12]. Future research should explore the long-term impacts of these interventions and investigate how different community contexts influence the trajectory, adoption, and sustainability of PSE changes. Moreover, there is a need for more research on the role of digital tools in enhancing community capacity and engagement, especially as the pandemic accelerated the shift toward virtual collaboration. To support community actions towards PSE changes, long term community-based research support is critical as a longer time working with communities translates into greater magnitude of PSE changes.
Acknowledgments
We would like to express our deepest gratitude to the community changemakers who generously shared their insights and experiences. Your dedication and commitment to improving local conditions have been invaluable to and are the foundation of this work.
References
- 1. Felmingham T, Backholer K, Hoban E, Brown AD, Nagorcka-Smith P, Allender S. Success of community-based system dynamics in prevention interventions: A systematic review of the literature. Front Public Health. 2023;11:1103834. pmid:37033017
- 2. Brennan LK, Sabounchi NS, Kemner AL, Hovmand P. Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity. J Public Health Manag Pract. 2015;21 Suppl 3:S55-69. pmid:25828223
- 3. Carey G, Crammond B. Systems change for the social determinants of health. BMC Public Health. 2015;15:662. pmid:26168785
- 4. Ewart-Pierce E, Mejía Ruiz MJ, Gittelsohn J. “Whole-of-Community” Obesity Prevention: A Review of Challenges and Opportunities in Multilevel, Multicomponent Interventions. Curr Obes Rep. 2016;5(3):361–74. pmid:27379620
- 5. McLeroy KR, Kegler M, Steckler A, Burdine JM, Wisotzky M. Community coalitions for health promotion: summary and further reflections. Health Educ Res. 1994;9(1):1–11. pmid:10146731
- 6. Amadei B. A Systems Approach to Building Community Capacity and Resilience. Challenges. 2020;11(2):28.
- 7. Hacker K, Tendulkar SA, Rideout C, Bhuiya N, Trinh-Shevrin C, Savage CP, et al. Community capacity building and sustainability: outcomes of community-based participatory research. Prog Community Health Partnersh. 2012;6(3):349–60. pmid:22982848
- 8. Goodman RM, Speers MA, McLeroy K, Fawcett S, Kegler M, Parker E, et al. Identifying and defining the dimensions of community capacity to provide a basis for measurement. Health Educ Behav. 1998;25(3):258–78. pmid:9615238
- 9. Liberato SC, Brimblecombe J, Ritchie J, Ferguson M, Coveney J. Measuring capacity building in communities: a review of the literature. BMC Public Health. 2011;11:850. pmid:22067213
- 10. Israel BA, Coombe CM, Cheezum RR, Schulz AJ, McGranaghan RJ, Lichtenstein R, et al. Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. Am J Public Health. 2010;100(11):2094–102. pmid:20864728
- 11. Kumanyika SK. Advancing Health Equity Efforts to Reduce Obesity: Changing the Course. Annu Rev Nutr. 2022;42:453–80. pmid:35417194
- 12. Moore TR, Calancie L, Hennessy E, Appel J, Economos CD. Changes in systems thinking and health equity considerations across four communities participating in Catalyzing Communities. PLoS One. 2024;19(10):e0309826. pmid:39441877
- 13. Fetters MD, Curry LA, Creswell JW. Achieving integration in mixed methods designs-principles and practices. Health Serv Res. 2013;48(6 Pt 2):2134–56. pmid:24279835
- 14. Calancie L, Nappi D, Appel J, Hennessy E, Korn AR, Mitchell J, et al. Implementing and Evaluating a Stakeholder-Driven Community Diffusion-Informed Early Childhood Intervention to Prevent Obesity, Cuyahoga County, Ohio, 2018-2020. Prev Chronic Dis. 2022;19:E03. pmid:35050848
- 15. Bess KD. Reframing coalitions as systems interventions: a network study exploring the contribution of a youth violence prevention coalition to broader system capacity. Am J Community Psychol. 2015;55(3–4):381–95. pmid:25828646
- 16. Fawcett SB, Collie-Akers VL, Schultz JA, Kelley M. Measuring Community Programs and Policies in the Healthy Communities Study. Am J Prev Med. 2015;49(4):636–41. pmid:26384934
- 17. Leeman J, Calancie L, Hartman MA, Escoffery CT, Herrmann AK, Tague LE, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: a systematic review. Implement Sci. 2015;10:80. pmid:26018220
- 18. Wandersman A, Duffy J, Flaspohler P, Noonan R, Lubell K, Stillman L, et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol. 2008;41(3–4):171–81. pmid:18302018
- 19. Golden SD, McLeroy KR, Green LW, Earp JAL, Lieberman LD. Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Educ Behav. 2015;42(1 Suppl):8S-14S. pmid:25829123
- 20.
Butterfoss FD, Kegler M. Toward a comprehensive understanding of community coalitions. Emerging theories in health promotion practice and research. 2002. p. 157–93.
- 21. Economos CD, Hyatt RR, Must A, Goldberg JP, Kuder J, Naumova EN, et al. Shape Up Somerville two-year results: a community-based environmental change intervention sustains weight reduction in children. Prev Med. 2013;57(4):322–7. pmid:23756187
- 22. Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev. 2015;2015(6):CD009905. pmid:26075988
- 23. Patay D, Ravuvu A, Iese V, Wilson D, Mauli S, Maelaua J, et al. Catalysing sustainable development through regional food system governance: Strengthening the translation of regional food system policy guidance to national level in the Pacific. Sustainable Development. 2023;32(1):1261–78.