Background
Get Fit Kauai is the Nutrition and Physical Activity Coalition of Kauai County, a rural island community in Hawaii. Since 2009, Get Fit Kauai has made significant progress in addressing the built environment through multiple policy and program strategies. For example, Get Fit Kauai was instrumental in helping to pass a Complete Streets county resolution, Safe Routes to School state legislation, and, most recently, a change to the county subdivision ordinance that requires sidewalks and shorter block lengths. The purpose of this study is to understand how Get Fit Kauai was able to successfully catalyze policy changes that impact the built environment and what the role of a community coalition is in policy implementation..

Objectives
The primary objective of this study was to gain an understanding of the process through which a community coalition was able to create and implement policy changes that impact the built environment. Secondary objectives of the study included identifying the enabling factors as well as the barriers to policy change and implementation, examining the influence of community context, and determining ways that the coalition could improve its efforts.

Methods
This qualitative study consisted of in-depth interviews with 25 coalition stakeholders. Interview participants were purposefully selected for their unique insights into coalition activities. Interviews were semi-structured, framed by an interview guide, and lasted approximately one hour. A grounded theory approach guided data collection and analysis (Charmaz, 2006). To help validate the interview findings, multiple member checks were conducted (Creswell, 2013), including presenting preliminary results to coalition groups and asking for feedback from interview participants on a draft report. In addition, other data sources such as coalition progress reports, news articles, and policy documents were reviewed to fill in gaps in information obtained from interviews.

Results
Of the 25 interview participants, 52% were women, 64% were at least 45 years old, 56% identified as Caucasian, 48% had a Master’s or other graduate degree, and 68% were involved with the coalition as part of their jobs. Nearly half (44%) worked for county government agencies, including Planning and Public Works.   Participants viewed Get Fit Kauai as critical to achieving the policy changes because of the resources it contributed to capacity building efforts, its activities to increase public awareness of the link between the environment and active lifestyles, and how it coordinated member testimony before County Council. In addition to the policy changes, Get Fit Kauai organized Walk to School Days through its Safe Routes to School Task Force; held annual Mayor-a-thon events in which hundreds of community members celebrated using the coastal path; trained coalition members to lead community planning charrettes; and developed performance measures to track the progress of Complete Streets policy implementation.   One of the major themes to emerge was capacity building, which was seen as an essential first step in the process of policy change. Get Fit Kauai had the resources to hire a progression of national consultants that provided education, training, and targeted technical assistance to the County of Kauai departments and coalition members. The capacity building helped to break down silos between departments and generated support for policy changes. Other contributing factors to policy change were political support from the Mayor and County Council, an effective coalition director, garnering significant local media coverage, and using the Built Environment Task Force as a vehicle for discussion and decision-making for policy strategies.   The community context was mostly supportive of the built environment policy changes. As a small, rural community, people knew each other and cared deeply about preserving the unique character of the island. To overcome a barrier to implementation, one of the identified next steps for Get Fit Kauai was helping to educate communities about the Complete Streets policy and how implementation would not ruin the rural island character.

Conclusions
Get Fit Kauai played a critical role in helping to pass policy changes addressing Complete Streets and Safe Routes to School. For policy implementation, the role of the coalition is evolving into a more supportive one as the county government takes over the lead. Nevertheless, Get Fit Kauai still has meaningful functions to carry out, including community education and holding the county accountable for implementation.

Implications
Other coalitions undertaking similar efforts can learn several lessons from Get Fit Kauai. One of the lessons is to have patience: it will take time to see changes on the ground. Although the County is working hard to implement pilot projects, community members need to understand how long the process takes. Another lesson is that multiple champions are needed at different levels and in different places to keep pushing the work forward. Finally, Get Fit Kauai’s director was identified as the driving force behind the coalition, and other leaders can learn from her approaches in recruiting and motivating people to do the coalition work.

References

1. Charmaz, K. (2006). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Thousand Oaks, CA: Sage Publications, Inc.
2. Creswell, J. W. (2013). Qualitative Inquiry & Research Design: Choosing Among Five Approaches. Thousand Oaks, CA: Sage Publications, Inc.

Support / Funding Source
This study was funded by the Hawaii State Department of Health, Healthy Hawaii Initiative, through Tobacco Settlement Special Funds. Get Fit Kauai is funded by the Healthy Hawaii Initiative and received additional funding through Communities Putting Prevention to Work, Centers for Disease Control and Prevention.