Readiness of communities to engage with childhood obesity prevention initiatives in disadvantaged areas of Victoria, Australia

Assessing readiness for childhood obesity prevention in German municipalities: application of the community readiness model

The World Health Organization has identified childhood obesity as one of the most serious public health problems of the 21st century. Understanding a municipality's readiness to address it is crucial to achieve successful interventions. However, the preparedness of German municipalities to address childhood obesity has not yet been investigated. This study is the first in Germany to apply the community readiness model (CRM) in this context. The purpose was to determine readiness of five municipalities for childhood obesity prevention and to identify factors that influence their readiness. Therefore, 27 semi-structured key informant interviews were conducted. First, the interviews were analysed following the CRM protocol to categorize the municipalities into a readiness level between one and nine. In a second step, a content analysis was carried out for an in-depth interpretation of the readiness scores. The municipalities achieved an average readiness of 3.84, corresponding to the 'Vague Awareness' stage. A lack of prioritization and leadership support, insufficient low-threshold efforts, a lack of knowledge and problem awareness as well as a lack of structures and resources were identified as factors that can determine municipal readiness to prevent childhood obesity. This study not only extends the application of the CRM to childhood obesity in German municipalities but also offers practical implications for professionals in assessing readiness.

Improving community readiness among Iranian local communities to prevent childhood obesity

BACKGROUND

Community Readiness Intervention for Tackling Childhood Obesity (CRITCO) is a theory-based intervention being developed to improve the readiness of an Iranian urban population to engage in childhood obesity prevention programs. This study aimed to explore changes in readiness of intervention and control local communities from diverse socio-economic areas of Tehran.

METHODS

This study was a seven-month quasi-experimental intervention implemented in four intervention communities and compared with four controls. Aligned strategies and action plans were developed around the six dimensions of community readiness. The Food and Nutrition Committee was established in each intervention community to make collaborative efforts among different sectors and assess the fidelity of the intervention. The pre-and post- readiness change was explored through interviews with 46 community key informants.

RESULTS

The total readiness of intervention sites increased by 0.48 units (p < 0.001) and shifted to the next higher level, from preplanning to the preparation stage. At the same time, the readiness of control communities decreased by 0.39 units (p < 0.001), although their readiness stage remained unchanged, reflecting the fourth stage. Also, a sex-dependent CR change was observed, such that the girls' schools showed a more remarkable improvement in interventions and less decline in controls. The readiness stages of interventions significantly improved for four dimensions related to community efforts, knowledge of the efforts, knowledge of childhood obesity issue, and leadership. Furthermore, the readiness of control communities significantly decreased on three of six dimensions related to community effort, knowledge of efforts, and resources.

CONCLUSIONS

The CRITCO successfully improved the readiness of intervention sites for addressing childhood obesity. It is hoped that the present study can be a spark for developing readiness-based childhood obesity prevention programs in Middle Eastern and other developing countries.

TRIAL REGISTRATION

The CRITCO intervention was registered at Iran Registry for Clinical Trials ( http://irct.ir ; IRCT20191006044997N1) on 11/11/2019.

Assessing community readiness to reduce consumption of sugary drinks in remote Aboriginal and Torres Strait Islander communities: A useful tool for evaluation and co-design

ISSUE ADDRESSED

There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non-Indigenous practitioners culturally adapted and applied the Tri-Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness.

METHODS

Aboriginal community-controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12-month follow-up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks.

RESULTS

The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre-defined issue, time and resource-intensiveness of the process, and need to review appropriateness prior to implementation in other regions.

CONCLUSION

The adapted CRT was valuable for evaluating the project and co-designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. SO WHAT?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns.

Adapting the Community Readiness Model and Validating a Community Readiness Tool for Childhood Obesity Prevention Programs in Iran

OBJECTIVES

It is critical to assess community readiness (CR) when implementing childhood obesity prevention programs to ensure their eventual success and sustainability. Multiple tools have been developed based on various conceptions of readiness. One of the most widely used and flexible tools is based on the community readiness model (CRM). This study aimed to adapt the CRM and assess the validity of a community readiness tool (CRT) for childhood obesity prevention programs in Iran.

METHODS

A Delphi study that included 26 individuals with expertise in 8 different subject areas was conducted to adapt the CRM into a theoretical framework for developing a CRT. After linguistic validation was conducted for a 35-question CR interview guide, the modified interview guide was evaluated for its content and face validity. The quantitative and qualitative analyses were performed using Stata version 13 and MAXQDA 2010, respectively.

RESULTS

The Delphi panelists confirmed the necessity/appropriateness and adequacy of all 6 CRM dimensions. The Persian version of the interview guide was then modified based on the qualitative results of the Delphi study, and 2 more questions were added to the community climate dimension of the original CRT. All questions in the modified version had acceptable content and face validity. The final CR interview guide included 37 questions across 6 CRM dimensions.

CONCLUSIONS

By adapting the CRM and confirming linguistic, content, and face validity, the present study devised a CRT for childhood obesity prevention programs that can be used in relevant studies in Iran.

Application of the Community Readiness Model for childhood obesity prevention: a scoping review

The Community Readiness Model (CRM) provides an approach to determine community readiness (CR), which is the degree of a community's preparedness to address a health issue. This scoping review aims to characterize internationally existing applications of the CRM for childhood obesity prevention. Therefore, a systematic literature research was conducted in PubMed, Cochrane Library, LIVIVO and Google Scholar. Of 285 identified records, 17 studies met the eligibility criteria and were included in the scoping review. The CRM has already been applied to childhood obesity prevention in the USA (n = 10), Australia (n = 4), UK (n = 1), Iran (n = 1) and South Africa (n = 1). Mainly geographically defined communities (n = 12) like counties and cities were analysed but also schools (n = 4) and churches (n = 1). The scoping review revealed various methodological changes to the standard protocol of which some are particularly relevant for the application to childhood obesity prevention. The identified studies reported readiness scores in the low to mid-range of the nine-point readiness scale. To increase CR, strategies were proposed that addressed raising awareness and knowledge of childhood obesity, but also supporting connectivity in and between settings. This scoping review provides researchers and health promoters with an overview of international CR measurements and setting-specific strategies to increase CR. It highlights the potential of targeted interventions to increase readiness and shows tentative support for the assumption of a possible link between CR level and changes in obesity prevalence.

Enabling Better Nutrition for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents

The unyielding obesity epidemic in adolescents from Middle Eastern (ME) backgrounds warrants culturally-responsive and co-designed prevention measures. This study aimed to capture the opinions of ME parents residing in Australia on the crisis and their enablers and barriers to healthy eating interventions given their influence on adolescent eating behaviors. Twenty-six semi-structured interviews were conducted with ME mothers, aged 35-59 years, and most residing in low socioeconomic areas (n = 19). A reflexive thematic analysis using the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework was conducted. Parents expressed confidence in knowledge of importance of healthy eating, but were reluctant to believe behaviours were engaged in outside of parental influence. Time management skills are needed to support working mothers and to minimize reliance on nearby fast-food outlets, which was heightened during COVID-19 with home-delivery. Time constraints also meant breakfast skipping was common. A culture of feeding in light of diet acculturation and intergenerational trauma in this diaspora was also acknowledged. Parents pleaded for upstream policy changes across government and school bodies to support parental efforts in the form of increased regulation of fast-food and subsidization of healthy products. Opportunities for weight-inclusive programs including parenting workshops underpinned by culturally-responsive pedagogy were recommended.

Community readiness for childhood obesity prevention programs: findings from an urban population in Iran

This study aimed to examine the Iranian local communities' readiness stage to engage with childhood obesity prevention programs for late primary school children in districts 2 and 16 of Tehran as the representatives of high and low socio-economic districts, respectively. First, a Delphi approach was conducted to assess the socio-cultural necessity/appropriateness and adequacy of the community readiness model and its dimensions as a planning basis for childhood obesity prevention program(s) in Iran. Then, the community readiness interview guide's translation, modification, content and face validity were performed. Finally, 66 interviews with key informants were conducted and scored to assess community readiness. The socio-cultural necessity/appropriateness and adequacy of community readiness model and its dimensions were confirmed by Delphi participants and two questions were added to the interview guide. Content and face validity of the interview guide were at acceptable levels. Assessment of the community readiness based on the key informants' perspective showed that the overall mean readiness score of targeted local communities was 4.61 ± 0.54 and 4.22 ± 0.26 in high and low socio-economic districts, respectively, corresponded to 'preplanning stage'. The highest score was 5.00 ± 0.48 correspond to the 'preparation stage', which belonged to girls' schools in district 2. Small differences were found in the readiness stage of local communities by sex and socio-economic status of schools. The results highlight the need to increase community awareness, gain their support to recognize childhood obesity as a priority, address cultural misconceptions and improve the obesity prevention programs to achieve a higher level of readiness.

A rural community moves closer to sustainable obesity prevention - an exploration of community readiness pre and post a community-based participatory intervention

Background

Understanding levels of community readiness can result in prevention efforts that align with communities’ ability and capacity for change and, therefore, be more effective and sustainable. Our study aimed to use baseline (pre-intervention) community readiness scores to assist with the development of obesity prevention strategies, and to assess changes in community readiness over time (pre/post- intervention), to provide evidence of intervention impact.

Method

Our study was located in a rural and remote area of Victoria, Australia. Community readiness was part of a broader obesity prevention intervention designed to create healthier food and physical activity environments through the combination of systems thinking and collaborative community-led solutions. Interviews were conducted using the community readiness to change tool in 2016 (pre) and 2018 (post) with a community representative sample. Baseline data informed the development of community relevant strategies and the pre/post results formed part of the overall evaluation.

Results

The tool generated both quantitative and qualitative (quotes) data. A final readiness score was calculated that corresponded to one of the nine stages of readiness. Four of the five domains of the community readiness to change tool showed statistically significant improvements over time (p < 0.05): knowledge of effort, knowledge of issue, community climate, and leadership. The resources domain that did not improve pre/post intervention.

Conclusion

Community readiness to change interviews, pre- and post- intervention, provided essential information related to the appropriate targeting and pitch of the prevention strategies, as well as providing an overall evaluation of the positive movement in the community’s readiness to implement change.

How ready are communities to implement actions to improve diets of adolescent girls and women in urban Ghana?

Background

Ghana has reached an advanced stage of nutrition transition, contributing to an increase in nutrition-related non-communicable diseases, particularly amongst urban women. Community involvement is an important factor in the success of efforts to promote healthy eating. The readiness of populations to accept a range of interventions needs to be understood before appropriate interventions can be implemented. Therefore, this study assessed how ready urban communities are to improve diets of women of reproductive age in Ghana.

Methods

Using the Community Readiness Model (CRM), in-depth interviews were conducted with 24 key informants from various sectors in low income communities across two cities in Ghana: Accra and Ho. The CRM consists of 36 open questions addressing five readiness dimensions (community knowledge of efforts, leadership, community climate, knowledge of the issue and resources). Interviews were scored using the CRM protocol with a maximum of 9 points per dimension (from 1 = no awareness to 9 = high level of community ownership). Thematic analysis was undertaken to gain insights of community factors that could affect the implementation of interventions to improve diets.

Results

The mean community readiness scores indicated that both communities were in the “vague awareness stage” (3.35 ± 0.54 (Accra) and 3.94 ± 0.41 (Ho)). CRM scores across the five dimensions ranged from 2.65–4.38/9, ranging from denial/resistance to pre-planning. In both communities, the mean readiness score for ‘knowledge of the issue’ was the highest of all dimensions (4.10 ± 1.61 (Accra); 4.38 ± 1.81 (Ho)), but was still only at the pre-planning phase. The lowest scores were found for community knowledge of efforts (denial/resistance; 2.65 ± 2.49 (Accra)) and resources (vague awareness; 3.35 ± 1.03 (Ho)). The lack of knowledge of the consequences of unhealthy diets, misconceptions of the issue partly from low education, as well as challenges faced from a lack of resources to initiate/sustain programmes explained the low readiness.

Conclusions

Despite recognising that unhealthy diets are a public health issue in these urban Ghanaian communities, it is not seen as a priority. The low community readiness ratings highlight the need to increase awareness of the issue prior to intervening to improve diets.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6989-5) contains supplementary material, which is available to authorized users.

Dissecting and customising the Childhood Obesity Prevention Advisory Council (COPAC): the development and application of a community engagement framework to improve childhood obesity prevention among migrant populations

Background: Migrant communities in Australia bear a disproportionate childhood obesity burden. They also show poor engagement in obesity prevention initiatives which may contribute to widening obesity disparities. Community engagement has been shown to be effective in reducing health disparities by improving migrant communities’ participation in prevention programmes.

Objective: This study aimed to develop a community engagement framework to improve childhood obesity prevention among migrants.

Design: Based on the African Review Panel model and the Community-Based Participatory Research conceptual logic model, the Childhood Obesity Prevention Advisory Council (COPAC) framework was developed and established in four disadvantaged areas in Victoria, Australia. The COPAC included service providers and migrant community members from the same project’s site.

Results: COPAC demonstrated several benefits including cross-organisational and multidisciplinary collaborations; understanding of the cultural barriers in childhood obesity prevention; enthusiasm from the COPAC members in addressing childhood obesity in their multicultural communities; equitable involvement, motivation, and empowerment of COPAC members in research development; and establishing organisational affiliations to foster long-term community involvement. This study also documented several challenges in community engagement including lack of prioritisation of migration-related childhood obesity disparities by the policymakers; staffing constraints among service providers leading to frequent disruptions in COPAC members’ contributions; and lack of adequate training and skill-building of bicultural workers.

Conclusions: The COPAC model adopted a flexible and dynamic community engagement process to suit the ongoing needs of the migrant community which incorporated the existing talents and resources within the community. For effective community engagement of migrant communities, it is important for policymakers to develop the knowledge, capacity and skills of the bicultural migrant workforce. Integrating both service providers and migrant community members in the COPAC has demonstrated that a multifaceted community-led approach has the potential to reduce childhood obesity-related disparities in Australia.