RWJF received 540 brief proposals for the second round of HKHC funding in February 2009, after launching 9 leading sites in December 2008. From this pool, 110 community partnerships were invited to submit full proposals. Finally, 41 grantees were selected from 105 full proposal submissions based on guidelines laid out in the call for proposals and on reviewers' predetermined criteria. Reviewers included RWJF staff, HKHC staff, members of the National Advisory Committee for the HKHC initiative, and other external representatives with expertise in childhood obesity prevention or community-based initiatives. Each review committee had at least 1 representative from each group. Communities were considered high-priority if they had a high representation of children from low-income households, had a high percentage of racial/ethnic minority groups at higher risk of obesity, and were in states with a high prevalence of childhood obesity (Alabama, Arkansas, Arizona, Florida, Georgia, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Tennessee, Texas, South Carolina, and West Virginia).
HKHC defined a community as a municipality, county, or region. The HKHC call for proposals focused on approaches that involved policy, systems, and environmental changes for preventing childhood obesity in settings outside the school day. Although the community partnerships were to propose their best thinking on the types of changes they might pursue, the grant program included a planning period during which communities conducted assessments and received technical assistance from the HKHC National Program Office to refine their strategies to meet their community's needs. The HKHC call for proposals was developed independently from the CDC recommendations, despite RWJF involvement in both. The technical assistance provided to applicants focused on guiding them toward selecting approaches that focused on policy, systems, and environmental changes and not on selecting specific strategies.
Proposals were submitted to RWJF using an online submission system. Funding decisions were based on need, apparent capacity, feasibility of implementation, and geographic and demographic diversity. The detailed content analysis described in this article was limited to full proposals submitted by the 41 HKHC grantees.
We analyzed the content of proposals in a 3-step process that used standardized abstraction and analysis forms. In Step 1, information from the proposal narrative was abstracted into Excel spreadsheets and classified according to the following themes: organizational capacity (description, mission, and unique characteristics); community partnerships (lead agency background, age of partnerships, key partners, previous work); proposed initiative (plan, evidence used, goals, major activities, and outcomes); and readiness (previous assessments, support from decision makers and politicians). Variables describing the communities and partnerships were quantified from the abstracted information. A more detailed analysis conducted on abstracted sections described communities' proposed plans and strategies to map them onto the CDC recommendations. In Step 2, the proposed HKHC strategies were sorted into the 6 broad categories of CDC recommendations described in the box. In Step 3, each proposed strategy was matched with the corresponding CDC recommendation in the identified category. For some, information was available only for broad initiatives from the community; such cases were classified as "strategy to be determinedd" under the appropriate category. The research staff conducted the initial proposal abstraction (Step 1) under the supervision of one of the authors (L.B.). The lead author (P.O.V.) mapped and matched proposed strategies (Steps 2 and 3) with help from a trained research assistant; they both mapped the proposed strategies onto the CDC recommendations, and in cases of disagreement a resolution was made in consultation with another author (L.C.L.).
Most of the community strategies proposed were highly consistent with the CDC recommendations and with CDC's suggested indicators to measure progress over time. If a community strategy matched the general aim of a CDC recommendation but was not consistent with the proposed CDC indicator of progress, it was classified as a match with the CDC recommendation. For example, CDC recommendation 18 is to enhance infrastructure to support walking. This recommendation can include a variety of efforts to promote walking; however, the suggested indicator of progress quantifies only paved sidewalk miles in the jurisdiction. HKHC communities chose various strategies to enhance walking, in addition to paving new sidewalks: signalized intersections, signage, and traffic-calming measures. All these strategies were classified as consistent with the CDC recommendation 18.
Although CDC used 6 general categories of recommendations, we analyzed only 4 in the analysis. Given HKHC's focus on children aged 3 to 18 years, communities did not propose to encourage breastfeeding (CDC category 3). Also, because the HKHC call for proposals required communities to work through multidisciplinary partnerships (CDC category 6), all communities had established partnerships, and no variability in assessment was anticipated.
Not all of the community strategies fit the CDC recommendations. Nevertheless, all community strategies were abstracted to capture the HKHC partnerships' understanding of the possible approaches to policy, systems, and environmental change. These strategies were categorized as community gardens, food policy councils, health promotion, and education.