From Systems to Sidewalks — Shaping Communities for Better Health
From Systems to Sidewalks — Shaping Communities for Better Health
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Featuring Dr. Michelle Grocke-Dewey
Associate Professor and MSU Extension Health & Wellness Specialist
Physical activity provides important health benefits and plays an important role in preventing chronic disease, while supporting physical, mental, and overall well-being. Despite widespread awareness of its benefits, many people face barriers that make active living difficult. Sidewalks, lighting, transportation access, community design, and perceptions of safety all influence whether movement feels attainable within daily life.
The Center for Nutrition & Health Impact (CNHI) and partners at Montana State University (MSU), with funding from the National Institutes of Health, collaborated on a R21 study titled Built Environment Approaches to Physical Activity: Testing Community-Driven Implementation Strategies. This study explores how MSU Extension can support Extension Agents (field faculty housed in county offices) to create environments that make physical activity more accessible and sustainable through community-driven approaches. Rather than focusing solely on individual education or motivation, the work shifts attention toward the environments, systems, and community conditions that help make healthy choices possible. The study is led by Dr. Laura Balis, Senior Research Scientist at CNHI, and collaborator Dr. Michelle Grocke-Dewey, Associate Professor and MSU Extension Health & Wellness Specialist.
For Dr. Grocke-Dewey, conversations around physical activity often overlook the role environments play in shaping health behaviors. As she explained,
"people often assume that someone's physical inactivity is primarily an issue of that individual lacking motivation and/or the knowledge of physical activity's importance for health ... but it's more than that. Many communities face real environmental barriers that make it difficult for individuals to get outside and move, in whatever way is suitable for them. Safe places for physical activity are not equally available, and those environments matter."
Promoting physical activity – especially through changing environments and policies – is a fairly new concept in Extension. Recognizing that Extension Agents are often best positioned to identify their own barriers and opportunities to implement new initiatives, the study team intentionally avoided a one-size-fits-all approach. Instead, they partnered with eight MSU Extension Agents representing communities across Montana to co-design implementation strategies that would best support them in improving community design.
Those conversations ultimately shaped three implementation strategies: technical assistance, toolkit, and funding support (see below). Rather than serving as standalone resources, these approaches created an integrated support system designed to help Extension Agents move local ideas toward action and navigate challenges along the way.
Technical assistance provides flexible support through one-on-one support sessions. In these virtual meetings, Extension Agents can brainstorm ideas, troubleshoot challenges, and receive guidance from the CNHI/MSU team from project planning to implementation.
The toolkit helps Extension Agents move ideas into action by offering implementation guidance, project planning resources, visual examples, and projects at varying funding levels. It also introduces demonstration projects that allow communities to test ideas and build support before pursuing larger investments. Over time, the toolkit has become both an implementation resource and a communication tool, helping Extension Agents more easily communicate with local leaders to better understand built environment concepts.
Funding support connects Extension Agents with aligned opportunities and provides assistance throughout the grant development process.
These approaches reflect a core principle of the study: meaningful change happens when the on-the-ground implementers help guide and shape the process. Developed alongside Extension Agents and informed by local perspectives, the implementation strategies have fostered strong ownership and growing momentum.
Across Montana, Extension Agents are already turning strategies into action.
In Choteau, Montana, Extension Agent Shelby Jones-Dozier took advantage of technical assistance, the toolkit, and funding support. She secured funding from the American Association for Retired Persons (AARP) to conduct walk audits with older adults. This created an opportunity for residents to share their experiences navigating local spaces. Participants identified disconnected sidewalks and unsafe intersections as barriers limiting movement and walkability. Their feedback is now helping inform larger funding efforts focused on safer intersections, improved walking corridors, and streetscape enhancements that support accessibility for residents of all ages.
At Fort Belknap Indian Reservation, Extension Agent Hillary Maxwell also participated in technical assistance and subsequently received funding support. She and her local team also secured funding from AARP for a project that demonstrates how the built environment can support and preserve cultural identity. Plans include a walking path surrounding indigenous grounds alongside culturally meaningful features such as benches for older adults and signage in their native language. The team is also pursuing additional funding for an edible windbreak designed to teach community members about native foods and nutrition. More than a space for physical activity, the project creates opportunities to strengthen cultural connection, support intergenerational learning, and ensure community spaces reflect local traditions and values.
From improving walkability to strengthening cultural connection, these projects demonstrate that meaningful change begins by listening to communities and helping local priorities move toward action.
Through partnership and implementation expertise, CNHI has helped strengthen Agents’ abilities to implement approaches that move beyond traditional health education and toward broader policy, systems, and environmental change. Looking ahead, Dr. Grocke-Dewey sees opportunities extending far beyond Montana. Extension systems exist in every state and maintain longstanding relationships within communities, creating opportunities to rethink how physical activity interventions are delivered and sustained. The study also points toward an important implication for prevention efforts moving forward: lasting change may come not only from helping individuals make healthier choices, but from creating environments that make those choices easier, and accessible to all, in the first place.
That broader evolution is already changing how communities and Extension leaders think about physical activity and prevention. Dr. Grocke-Dewey reflected,
"we are seeing a shift in how Extension Agents think about physical activity promotion. Instead of focusing only on group exercise classes or individual education — which are important aspects of health promotion — there is growing excitement around also working to modify the local environment in ways that facilitate behaviors that we know are healthy."
As communities continue building local momentum, the project reinforces that prevention is not created through individual action alone. It is shaped through the environments, systems, and community spaces that make healthier futures possible.
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award number 5R21CA280503-02. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.