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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 8: Physical Activity

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Strategy. Green Space and Parks

Approach. Create new parks and green space or rehabilitate empty or under-utilized public areas to promote physical activity.

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Overview. Where children live and what they have access to in regards to areas and opportunities for physical activity are important considerations for communities who want to promote physical activity. There are differences in physical activity access levels according to factors such as race, gender and socioeconomic status, for example (National Physical Activity Plan Alliance, 2018). By improving access to green space and parks, through renovations or rehabilitation of under-utilized or abandoned spaces can be a way to improve access to areas of physical activity and reduce barriers to physical activity. Examples of studies with positive outcomes included increasing the number of parks, length of sidewalks, and amount green space, as well as introducing community-organized play days in available public spaces.1, 2

Evidence. Emerging. Initial research showed positive results for strategies to increase physical activity by establishing new or refurbishing under-utilized public areas. Further research is needed to identify critical components and confirm effects. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Community.

Outcome.¬† Increased moderate to vigorous physical activity, decreased sedentary behavior. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the “Intervention Results” for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that aligns with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Create new parks and green space or rehabilitate empty or under-utilized public areas to promote physical activity,” here are sample ESMs you can use to model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of communities (cities, towns, etc.) with access to green space/parks.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of communities (cities, towns, etc.) with access to green space/parks.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of children/adolescents who use green space/parks.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of children/adolescents who perform moderate-to-vigorous physical activity in community green space/parks.
  • Percent of families that report increased physical activity because of the availability of green space/parks.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 Heath GW, Bilderback J. Grow healthy together: Effects of policy and environmental interventions on physical activity among urban children and youth. Journal of Physical Activity and Health. 2019 Feb 1;16(2):172-176.

2 Meyer MRU, Hamilton CNB, Prochnow T, McClendon ME, Arnold KT, Wilkins E, Benavidez G, Williams TD, Abildso CG, Porter KMP. (2019).Come together, play, be active: physical activity engagement of school-age children at Play Streets in four diverse rural communities in the US. Preventive Medicine. 2019 Oct;129:105869.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.