| Many leaders believe that local communities should play a role in preventive health. Within the United States (U.S.), some form of governmental agency typically manages local public facilities, spaces, lands, and recreation programs. These departments are usually identified as parks and recreation (P&R) or some similar variation. Public health (PH) evidence has increasingly pointed to local P&R agencies as a critical setting for promoting health. Addressing desired PH outcomes is a growing focus for P&R agencies, but many have limited resources or strategies on which to base their actions. However, the research base is also growing. The global research question has shifted from asking IF P&R agencies can positively affect PH factors, to HOW they can best do so with limited resources.;This dissertation research featured a mixed-methods approach including a thematic literature review, exploration through a three-stage Delphi panel study with 17 P&R agency Key Informants, and a case study of two larger P&R agencies to deepen findings and identify strategies for local P&R agencies. This study was iterative, with each stage informed through review with all Informants. To help with potential limitations of the research methods and/or possible constraints due to personal experience and affiliations, a focus was maintained on transparency, continued search for the evidence-base, and asking, "what is missing?";The study first explored preventive health factors modified by P&R. The research investigated the theoretical basis of systems theory and potential systems thinking approach applications for local P&R agencies. Systems theory has been used previously in business and PH applications to describe concepts of how various components, actors, factors, and processes within a given system work together, and to help identify barriers, gaps, and opportunities for improved effectiveness.;Results indicate that the primary modifiable PH factors for P&R include increased physical activity, improved nutrition, enhanced safety or perception of safety, increased social and parental engagement, improved transportation and access to locations (especially nature), and cessation or reduced overconsumption of tobacco and alcohol. However, community-specific data on many of these various health factors are not yet readily available to public agencies. The continuing challenge at the local P&R management level is knowing the priority of the factors for a specific agency and/or partners to address.;This study furthered the theoretical knowledge base for both research and practice through summary of the primary factors, interactions, initiatives, and potential strategies for P&R agencies to address to facilitate change. The research examined how agencies may use a systems thinking approach to prioritize. Results indicate that it is critical within the system to focus on leadership to create a strong organizational culture of PH from P&R a cultural ethic of inclusion and equity; allocation of staff and financial resources; equitable access to assets and programs; collaboration; utilization of crime prevention and design strategies; increased health promotions; and centralized tracking of feasible measures. Conclusions include an adapted framework for a community systems thinking approach related to addressing the factors. There is also a need for better dissemination of research, evidencebased tools, and established methods. A conceptual framework is suggested to further address the gaps in knowledge transferal between P&R research and practice realms. |
