A process evaluation of “Show Me Strong Kids”: Improving child health through pediatrician-led community partnerships

The COVID-19 pandemic created significant impediments to child healthcare, especially among rural and disadvantaged communities. Show Me Strong Kids (SMSK) is a statewide health initiative in which academic pediatricians collaborate with local physicians and leaders in under-resourced communities to create community coalitions for child health. The two core components of SMSK include a local roundtable of community leaders and a forum for community members to pose questions to child health experts. This mixed-methods study is a process evaluation of SMSK across four outcomes: fidelity (adherence), recruitment, indicators of maintenance, and contextual factors related to implementation. Data were collected from internal SMSK documentation, public health records, and key informant interviews. Quantitative data were used to calculate a composite health needs index for the state of Missouri. Qualitative data were coded using an inductive thematic approach. Eight communities received program delivery. Implementation fidelity was mixed, as only 62.5% of sites were rural and 37.5% considered high-need areas, which differed from the planned activities. Of the communities selected, 50% implemented pediatric-focused community health projects (three rural, one urban), though the scope and health focus of each project varied by community. Key informant interviews identified five major themes for successful implementation: availability of health care providers, engagement of physician champions, community trust, local leader collaboration, and ongoing support. Regarding collaboration, SMSK teams identified duplicative and underutilized resources across communities, which facilitated more streamlined child health initiatives. SMSK’s success in under-resourced communities depended on enthusiastic local physicians and adequate buy-in from local community leaders.