Shaping healthier futures: community-level impact of the Alberta Healthy Communities Approach.

The AHCA II involved 19 rural communities in Alberta participating in a community-based approach to creating healthy environments and addressing modifiable health behaviours.

• Nineteen rural communities participated in AHCA Phase II.
• The program targeted modifiable health behaviours including healthy eating, physical activity, ultraviolet radiation protection, and tobacco reduction.
• The approach aimed to prevent and reduce cancer and chronic disease.
• Multisectoral teams were formed to implement environmental and programmatic changes.

The evaluation used a mixed-methods approach triangulating qualitative and quantitative data sources collected with and by community members.

• Data collection included two pre- and post-implementation assessment tools.
• Post-implementation focus groups and surveys were also conducted.
• Data were collected with and by community members.
• Qualitative and quantitative data sources were triangulated to determine community-level outcomes and impacts.

The AHCA II produced three key intersecting outcomes: supportive (built) environments for health, community wellness culture, and community capacity.

• Multisectoral teams improved built environments through physical changes to community environments and programming.
• Programming supported healthy eating, physical activity, sun protection, and tobacco reduction.
• The three outcome categories were described as intersecting and mutually reinforcing.
• These outcomes were identified through triangulation of qualitative and quantitative data sources.

The AHCA facilitated physical changes to community environments as part of building supportive environments for health.

• Multisectoral teams implemented physical changes to community environments.
• Programming was developed to support healthy eating, physical activity, sun protection, and tobacco reduction.
• Built environment changes were intended to modify the physical places in which people live, work, and play.
• These changes addressed multiple environmental factors to reduce cancer and chronic disease risks.

The AHCA created a novel health and wellness culture within communities, increasing community engagement and participation in health-promoting initiatives.

• Community wellness culture was identified as one of three key outcomes.
• The approach facilitated cultural changes within and across rural communities in Alberta.
• Increased community engagement and participation in health-promoting initiatives was observed.
• Cultural change was described as necessary to support long-term behaviour changes.

Communities improved their capacity to collectively promote health by identifying determinants of health, improving multisectoral partnerships, and leveraging community resources.

• Community capacity was identified as one of three key outcomes of the AHCA.
• Capacity improvements occurred both within and across rural communities.
• Specific capacity-building mechanisms included identifying determinants of health, improving multisectoral partnerships, and leveraging community resources.
• Community capacity was described as a required component to support long-term behaviour changes.

Additional time and evaluations are required to determine whether behavioural changes are sustained and result in reduced rates of cancer and chronic disease.

• The authors noted that while results are encouraging, long-term sustainability of behavioural changes remains unconfirmed.
• It remains undetermined whether observed changes will translate into reduced rates of cancer and chronic disease.
• Each of the three outcome components—supportive environments, wellness culture, and community capacity—is described as required to support long-term behaviour change.
• The study did not measure cancer or chronic disease incidence rates as outcomes.