Extension as a backbone support organization for physical activity promotion: A collective impact case study from rural Kentucky

Margaret McGladrey, Angela Carman, Christy Nuetzman, Nicole Peritore

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: Rural counties in the United States face daunting structural issues that reduce their populations' physical activity levels, including geographic isolation as well as deficits in infrastructure, public transportation, health care providers, and funding. Methods: Funding from the Centers for Disease Control and Prevention provided an opportunity to assess how Extension enhanced the collective impact of systems-level physical activity promotion programming through a multisectoral coalition in Clinton County, Kentucky. Results: The Extension-led coalition accomplished the 6 essential functions of a backbone support organization by identifying obesity as a critical local issue (function 1: Providing overall strategic direction), developing a multisectoral coalition (function 2: Facilitating dialog between partners), compiling data on the county's physical activity infrastructure (function 3: Managing data collection and analysis), creating communication channels (function 4: Handling communication), organizing community awareness events (function 5: Coordinating community outreach), and securing additional grants (function 6: Mobilizing funding). The average rating of Extension's leadership across multiple dimensions by 3 coalition members in a postproject survey was "excellent" on a 5-point Likert scale. Conclusions: Extension is well positioned through their mission, broad community engagement, data collection, needs assessment, community and academic relationships, and embeddedness in local communities to serve as the backbone support organizations for rural physical activity promotion coalitions.

Original languageEnglish
Pages (from-to)62-67
Number of pages6
JournalJournal of Physical Activity and Health
Issue number1
StatePublished - 2020

Bibliographical note

Funding Information:
Ann Vail, University of Kentucky, served as the Principal Investigator for this grant overseeing all activities in all 6 participating Kentucky counties, including the coalition efforts described herein. Alison Gustafson, University of Kentucky, led the survey data collection and analysis effort involved in the community needs and assets assessment process. Janet Tietyen-Mullins, University of Kentucky, served as the evaluation team lead charged with developing and managing all comprehensive evaluation activities and reporting to the grant sponsor. Brooke Butterworth, a former graduate student of the University of Kentucky, worked closely with the lead author and Dr Tietyen-Mullins on the coalition-related data collection and analysis efforts as part of her master’s thesis project. This work was supported by a cooperative agreement with the Division of Nutrition, Physical Activity, and Obesity Program of the Centers for Disease Control and Prevention (5NU58DP005483).

Funding Information:
In addition to these comprehensive planning strategies, the Clinton EPHECTs mutually reinforcing activities included leveraging funding from sources beyond the CDC 1416 program grant to create convenient and safe opportunities for physical activity. In June 2016, funding from another grant was used to purchase childhood playground equipment and other multipurpose field development equipment for the Mountain View Recreation Park, which was installed by community members. The Clinton EPHECT also elected to purchase and install a safety fence to surround the new playground. In addition to this new infrastructure promoting children’s physical activity, the Clinton EPHECT installed bicycle racks and a fitness trail with 10 stations at the park and a new walking trail connecting the middle school to the county park with a mutual use agreement between the school and the parks and recreation department to ensure community access to the facilities. These outcomes indicate that the Clinton EPHECT was effective in mobilizing funding, one of the essential functions of a backbone support organization.

Funding Information:
The Clinton EPHECTs use of a shared measurement system to set and hold themselves accountable to the common agenda they had established during the needs and assets assessment process and their mutually reinforcing activities were maintained through Extension’s continuous communication to build trust, motivation, and understanding of objectives. Communication strategies included newsletters and monthly e-mail updates to Clinton EPHECT members, in-person Clinton EPHECT meetings at critical junctures, successful pursuit of local newspaper and radio coverage, and social media postings that reached thousands of residents. After a team of volunteers installed the new infrastructure in the park, the Clinton EPHECT hosted a community event that highlighted how the park and middle school areas can be jointly used by residents and how further enhancements can connect the 2 areas to maximize their use. More than 300 residents, including many families, attended the event that featured fun runs, a bike rodeo, and a kickoff for the community soccer program. The Clinton EPHECT also hosted a Community Health and Wellness Fair at the Extension office involving health care providers, managed care organizations, schools, and the community early childhood council to promote physical activity opportunities in February 2016. Furthermore, the collective impact facilitated by Extension as the backbone support organization resulted in new partnerships and funding opportunities, including funding from the Healthy Communities grant program, the Kentucky Department for Agriculture, and the Rural Child Poverty Nutrition Center. These results suggest that Clinton EPHECT was successful in achieving the final 2 essential functions of backbone support organizations: handling communication and coordinating community outreach.

Publisher Copyright:
© 2020 Human Kinetics, Inc.


  • And environment
  • Community-based coalitions
  • Cooperative Extension Service
  • Policy
  • Rural health
  • Systems

ASJC Scopus subject areas

  • Medicine (all)


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