Background
Communities across the country are implementing physical activity interventions and creating environmental and policy changes to support healthy behaviors. However, most of these programs are not evaluated or disseminated and, therefore, do not contribute to the growing body of practice-based evidence in support of these strategies. The Missouri Foundation for Health (MFH) established the Model Practice Building (MPB) strategy in 2007 to support previously funded healthy eating and physical activity projects that showed potential for becoming model practices. To be funded, projects had to demonstrate quantitative and qualitative evidence that the intervention has created some positive change to promote healthy and active living; active collaboration; replicable program elements; and elements of sustainability. A goal of this funding strategy was to identify projects that could be classified as model practices and then be disseminated and replicated across the state. To meet this need, an external evaluation and dissemination team funded by MFH worked together to define a model practice and operationalize criteria for dissemination and replication.

Objectives
To operationalize and apply a method for identifying model practice projects including programs, environment changes, and/or policies to be disseminated and replicated.

Methods
A model practice was defined as a practice exhibiting quantitative and qualitative evidence that the intervention has created some positive change to promote healthy and active living; active collaboration; replicable program elements; and elements of sustainability. The definition of a model practice was comprised of three primary components: innovation, effectiveness, and sustainability. The three components were operationalized and specific criteria were developed to determine if projects had elements of model practices.

To assess innovation and effectiveness, projects were ranked on a scale from 1 to 5 for each model practice component by multiple raters that were familiar with the MPB projects (MFH program officer, evaluation team, dissemination team). Raters were to consider the project design and the intervention and evaluation activities of each project as well as any processes that were in place to increase chances of sustainability. An average was taken across all components to develop an overall model practice score. To measure sustainability, a program sustainability assessment tool was administered to help measure if a project had the necessary practices and processes to sustain itself. This tool was designed to help identify the strengths and weaknesses of a program’s sustainability effort and included all of the criteria identified for the sustainability component (ranked on a scale from 1 to 7).

Results
A model practice is comprised of innovation, effectiveness and sustainability. These three components were operationalized as follows:

1. Innovation: recognizes the importance of identifying projects that approached obesity prevention in a new or unique way, building upon known best practices 

• Example criteria: implementation of an environmental or policy approach, the extent to which the grantee has engaged partners from diverse sectors

2. Effectiveness: refers to the ability of the project to successfully address obesity-related outcomes among the targeted population 

• Example criteria: the project design is linked to an existing evidence-based intervention or theory, fidelity of the project to evidence-based interventions

3. Sustainability: examines variables impacting the probability of continued implementation over time

• Example criteria: strategic planning, organizational capacity, funding stability

Based on this method, two interventions were identified as model practices. Based on the raters scoring, for innovation the lowest ranked projects, across all projects, received a 1 on innovation and the highest received a rating of 4. For both effectiveness and sustainability, ratings ranged from the lowest at 1.3 to the highest at 4.6. For the sustainability assessment tool, projects scored between 4.6 to 6.4.

Conclusions
The criteria developed for the model practice components (innovation, effectiveness, sustainability) are useful for identifying potential projects for replication and dissemination, contributing to the practice-based evidence. Other researchers and evaluators can apply these criteria to identify obesity prevention programs, environment changes, or policies that could be replicated in their community or as a method to determine if current projects have the potential for replication and dissemination.

Support/Funding
Funding for this project was provided by the Missouri Foundation for Health.