Journal Article

Implementation of Change Club action plans to promote built environment change in rural communities

Villarreal, Deyaun L., Eldridge, Galen D., Volpe, Leah C., Hanson, Karla L., Nelson, Miriam E., Graham, Meredith L., Lewis, Emma C., Folta, Sara C., Maddock, Jay E., Marshall, Grace A., Seguin-Fowler, Rebecca A.

2026

Overview

Background Rural United States communities often experience disproportionate burdens of obesity, cardiovascular disease, diabetes, and premature mortality. Built environment constraints, including limited sidewalks, recreation facilities, and access to nutritious foods, may restrict opportunities for adoption and maintenance of healthy eating and physical activity behaviors. Civic engagement approaches empower residents to assess community needs, develop action plans, and implement policy, systems, and environmental (PSE) strategies. However, few randomized trials have examined implementation of PSE strategies and their impacts in rural adult populations. This study evaluated implementation of Cooperative Extension-led Change Club (CC) community project action plans aimed at facilitating PSE change in six rural and micropolitan Texas and New York intervention communities. Presently, we document implementation outcomes and identify factors that may have influenced implementation using the Consolidated Framework for Implementation Research (CFIR). Methods CCs followed a 24-module curriculum facilitated by trained Extension educators. Approved action plans were provided with seed money to target diet and physical activity PSE changes. Implementation outcomes regarding the action plans were tracked through educator reports, interviews, and proposals. CFIR factors were assessed during the early stages of action plan implementation using interviews with educators and participant residents. Results All six intervention communities implemented action plans, most of which had multiple components. Each prioritized environmental changes and most focused on addressing physical activity. Implementation timing and continuity varied, influenced by external factors such as weather and local approvals. CFIR analysis identified beliefs about feasibility, stakeholder engagement, and group decision-making as key factors influencing implementation. Conclusions Rural CCs successfully launched a variety of built environment initiatives. This implementation evaluation highlights pathways and barriers related to scaling rural civic engagement strategies. Trial registration Clinical Trial #NCT05002660 (August 2021).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Behavioral Sciences / Built environment / Change club / Citizen participation / Civic engagement / Clinical Nutrition / Community / Community development / Curricula / Demographic aspects / Environmental aspects / Health aspects / Health Promotion and Disease Prevention / Human subjects / Implementation evaluation / Intervention / Medicine / Medicine & Public Health / Physical fitness / Planning / Public health / RCT / Rural / Rural areas / Social networks / Teachers