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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. Access to Places for Physical Activity

Approach. Support increased access to places for physical activity, or decreased financial barriers to places for physical activity.

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Overview. This multicomponent intervention is focused on increasing access to places for physical activity by creating new community spaces or reducing financial barriers to existing spaces for physical activity. Oftentimes these strategies can include education or training for participants. Examples of studies with positive outcomes used a variety of efforts to increase access to community space such as providing free passes to a local gym or YMCA.1

Evidence. Emerging. Initial research showed positive results for strategies that increase access to places for physical activity although further research is needed in this area to confirm impacts. 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.¬† Physical activity levels. 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 “Support increased access to places for physical activity, or decreased financial barriers to places for 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.) working to enhance access to places for physical activity (e.g., by creating walking trails, building exercise facilities, providing access to existing nearby facilities).
  • Number of communities (cities, towns, etc.) subsidizing changes to local environments to create new opportunities for physical activity.
  • Number of communities working to reduce barriers to access in community spaces for physical activity.

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

  • Percent of communities (cities, towns, etc.) with community space for physical activity.
  • Percent of children/adolescents who received subsidized passes to local gyms and community fitness centers.

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

  • Number of children/adolescents who use community space for physical activity.
  • Number of children/adolescents who report increased levels of physical activity.

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

  • Percent of children/adolescents who use community space to reach 60 minutes of moderate-to-vigorous physical activity per day.
  • Percent of communities who report increased access to programs and spaces for physical activities

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 Smith C, Clark AF, Wilk P, Tucker P, Gilliland JA. Assessing the effectiveness of a naturally occurring population-level physical activity intervention for children. Public Health. 2020;178:62-71.

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.