• Data Sharing Agreements result in accessible, relevant, and timely community data. • Stakeholder data training workshops support communities in surveillance efforts. • Surveillance as standard educational practice yields local population PA estimates. • Local data can drive community decisions regarding youth PA opportunities.

Background: Community-based coalitions are a common strategy for community engagement efforts targeting the improvement of a variety of population health outcomes. The typical processes that coalitions follow to organize efforts include steps that are sequential, slow, and time intensive. These processes also limit local decision-making to the selection of evidence-based policies or programs. Methods: We present a process control theory-based Community Action Process, Investigate-Design-Practice-Reflect (IDPR), where community hubs (i.e., coalitions) organize agile efforts in a non-sequential, rapid, and efficient manner to harness local assets and data to make decisions regarding the provision and production of population health services. Using qualitative methods, we illustrate and analyze the use of IDPR in a one community case study as part of Wellscapes, a Type 3-hybrid implementation-effectiveness community randomized controlled trial to improve children’s population health physical activity. Results: We found community members followed the IDPR Community Action Process to rapidly design, organize, deliver, and receive feedback on a community-based, children’s population physical activity prototype, an afterschool Play-in-the-Park opportunity for all children. Discussion: Following IDPR afforded the community coalition timely learning through feedback within a process that coordinated decisions regarding what community services met community needs (provision decisions) and how to organize the production of the population health services (production decisions).

Background: Approaches to prevent and manage diabetes at a community population level are hindered because current strategies are not aligned with the structure and function of a community system. We describe a community-driven process based on local data and rapid prototyping as an alternative approach to create diabetes prevention and care management solutions appropriate for each community. We report on the process and provide baseline data for a 3-year case study initiative to improve diabetes outcomes in two rural Nebraska communities. Methods: We developed an iterative design process based on the assumption that decentralized decision-making using local data feedback and monitoring will lead to the innovation of local sustainable solutions. Coalitions act as community innovation hubs and meet monthly to work through a facilitated design process. Six core diabetes measures will be tracked over the course of the project using the electronic health record from community clinics as a proxy for the entire community. Results: Baseline data indicate two-thirds of the population in both communities are at risk for prediabetes based on age and body mass index. However, only a fraction (35% and 12%) of those at risk have been screened. This information led both coalitions to focus on improving screening rates in their communities. Discussion: In order to move a complex system towards an optimal state (e.g., improved diabetes outcomes), stakeholders must have access to continuous feedback of accurate, pertinent information in order to make informed decisions. Conventional approaches of implementing evidence-based interventions do not facilitate this process.

The United States faces a maternal health crisis marked by stark racial disparities. Although doula support has emerged as an evidence-based intervention to improve perinatal outcomes by addressing social determinants of health, its integration into healthcare systems remains limited. This qualitative study, informed by phenomenological principles, examined multi-level experiences, perceived barriers, and perceived facilitators of integrating doula services into perinatal care systems and their intersection with health equity goals. We conducted 17 semi-structured interviews with 20 participants across Nebraska and Tennessee, including doulas, midwives, physicians, Medicaid administrators, and public health professionals, and analyzed data using reflexive thematic analysis guided by the Socio-Ecological Model. Three themes emerged: the integration paradox, an overarching theme capturing tensions between doula independence and healthcare system demands for standardization, including divergent views on practice models, provider dynamics, and certification; sustainable financing as the prevailing barrier, encompassing grant limitations, private pay inequities, absent Medicaid reimbursement, and the need for cost-effectiveness evidence; and cultural concordance as the prevailing facilitator, including cultural matching, addressing social determinants, and lived experience as motivation. Sustainable doula integration requires reconciling system demands for standardization with the relational, culturally responsive characteristics that define effective care, through Medicaid reimbursement pathways and policy reforms developed in partnership with doula communities.