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van Dongen BM, de Vries IM, Ridder MAM, de Boer M, Steenhuis IHM, Renders CM. Building community capacity to stimulate physical activity and dietary behavior in Dutch secondary schools: Evaluation of the FLASH intervention using the REAIM framework. Front Public Health 2022; 10:926465. [PMID: 35991016 PMCID: PMC9381984 DOI: 10.3389/fpubh.2022.926465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Building community capacity in secondary schools is a promising strategy for the sustainable implementation of school-based health promotion. The Fit Lifestyle at School and at Home (FLASH) intervention explored how building community capacity works for the prevention of overweight following four strategies: leadership, participatory school culture, tailored health-promotion activities, and local networks. This study evaluates the intervention's impact on community capacity and capacity-building processes over a period of 3 years, as well as its effects on adolescents' BMI and waist circumference. Methods A mixed-methods design guided by the RE-AIM framework was used. Impact on community capacity was evaluated with semi-structured interviews at the start and end of the intervention and analyzed using an anchored coding scale. Capacity-building processes were evaluated using interviews, journals, questionnaires, and the minutes of meetings. The effects on BMI z-scores and waist circumference were evaluated using a quasi-experimental design comparing an intervention (IG) and reference group (RG), based on multi-level analyses. Results Community capacity improved across all intervention schools but varied between capacity-building strategies. Leadership recorded the greatest improvements, aided by the appointment of Healthy School Coordinators, who increasingly focused on coordinating processes and fostering collaborations. Participatory school culture also improved through the adoption and implementation of participatory methods and a general increase in awareness concerning the importance of the Healthy School approach. Although additional health-promotion activities were implemented, stakeholders struggled with tailoring these to the specific dynamics of their schools. Limited improvements were observed in setting-up local networks that could help schools encourage healthy behavior among pupils. Differences in BMI z-scores between IG and RG over the total sample were negligible whereas waist circumference increased slightly more in IG (0.99 cm, 95% CI [.04; 1.93]). However, differences were inconsistent over time and between cohorts. Conclusions This study highlights the potential of building community capacity. It emphasizes that this is a process in which stakeholders must become acquainted with new leadership roles and responsibilities. To navigate this process, schools need support in improving communication, establishing local networks, and sustaining capacity-building efforts in school policy. Trial registration ISRCTN67201841; date registered: 09/05/2019, retrospectively registered.
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Affiliation(s)
- Bonnie Maria van Dongen
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Bonnie Maria van Dongen
| | - Inge Maria de Vries
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Michiel de Boer
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of General Practice and Elderly Care, University Medical Center Groningen, Groningen, Netherlands
| | - Ingrid Hendrika Margaretha Steenhuis
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Carry Mira Renders
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, Netherlands
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Apriningsih A, Madanijah S, Dwiriani CM, Kolopaking R, Crosita Y. School Readiness in Weekly Iron Folic Acid Supplementation Program in Urban Area, West Java, Indonesia. AMERTA NUTRITION 2020. [DOI: 10.20473/amnt.v4i4.2020.291-298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:School based weekly iron and folic acid supplementation (WIFAS) program was aimed to decrease anemia prevalence and improve the adherence to consume iron tablet.Limited information on the school perspective and their readiness to implement the program.Objectives:To analyze program guidelines, stakeholders’ perspective and school readiness to implement the program which will help evaluate and improve adherence to WIFAS.Methods:Using cross sectional design with mixed method approach to utilize social ecological model and community readiness model.Results: Most of schools received awareness campaign regarding the program,only 38,9% have conducted a drinking together session once a week,only 27,8% recorded their students’ adherence.The average score for the school readiness was 3.36 (SD ±0.82), the school was in the vague awareness stage.There is a correlation between the score of school’s knowledge, attitude toward WIFAS program,City Health Authority and Education Regional Office ‘s support score, the total score of the school readiness, ever got socialization with implementation of WIFAS (r= 0.35, r=0.2, r=0.49, r=0.21, r= 0.66, r= 0.43, p value <0.005).The strongest correlation with implementation of WIFAS at school was the school readiness total score, ever received socialization and score school’s knowledge on WIFAS (p value <0.005) and City health Authority and Education regional office’s support score for WIFAS program as covariant (p >0.05).Conclusions: School readiness is important factor of community and environment which contribute to behavior change.School realize that anemia and schoolgirl adherence to consume WIFAS had to solved but did not know how and assume outside parties can help solve the problem.The City Health Authority and Education Regional Office is expected to help improve the school readiness to implement the program.
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Whelan J, Strugnell C, Allender S, Korn AR, Brown AD, Orellana L, Hayward J, Brown V, Bell C, Moodie M, Peeters A, Nichols M. Protocol for the measurement of changes in knowledge and engagement in the stepped wedge cluster randomised trial for childhood obesity prevention in Australia: (Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND)). Trials 2020; 21:763. [PMID: 32887655 PMCID: PMC7650215 DOI: 10.1186/s13063-020-04692-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community leaders within a whole-of-community systems intervention across 10 large intervention communities in Australia. Methods We will investigate the role of stakeholder knowledge and engagement in the implementation and effectiveness of the stepped wedge cluster randomised trial in ten communities in Victoria, Australia. Data will be collected using the Stakeholder-driven Community Diffusion Survey (SDCD) to measure levels of knowledge and engagement prior to commencement (2019), across the three separate levels of governance within the intervention at five time points. Primary outcomes will be baseline overall knowledge and engagement scores across the three levels of governance and change in overall knowledge and engagement over time. Discussion We hypothesise there will be heterogeneity between intervention sites on levels of knowledge and engagement and that these differences will be associated with variability in implementation success. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618001986268. Registered on 11 December 2018
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia.
| | - Claudia Strugnell
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Andrew D Brown
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | | | - Josh Hayward
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Vicki Brown
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Marj Moodie
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Melanie Nichols
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
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Whelan J, Love P, Millar L, Allender S, Morley C, Bell C. A rural community moves closer to sustainable obesity prevention - an exploration of community readiness pre and post a community-based participatory intervention. BMC Public Health 2019; 19:1420. [PMID: 31666042 PMCID: PMC6820900 DOI: 10.1186/s12889-019-7644-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Australia.
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lynne Millar
- Adjunct Fellow, Victoria University, Melbourne, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Australia
| | | | - Colin Bell
- Institute for Health Transformation, Global Obesity Centre, School of Health and Social Development, Deakin University, Geelong, Australia
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Harris KJ, Brown B, Shankle L, Tryon M, Pedersen M, Panarella SK, Swaney G. Community Readiness Model for Prevention Planning: Addressing Childhood Obesity in American Indian Reservation Communities. J Racial Ethn Health Disparities 2019; 6:1144-1156. [PMID: 31332689 DOI: 10.1007/s40615-019-00616-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The community readiness model (CRM) is a stage-matched assessment protocol to assess community readiness to address a public health issue. To identify appropriate, culturally sensitive, and community-specific intervention strategies for preventing obesity in children, researchers, and community members formed a partnership to address childhood obesity within one American Indian Reservation. METHODS The CRM guided 30 interviews in five communities to direct the team's efforts in addressing obesity among children residing on the reservation. Interviews were scored across six dimensions on an anchored scale of one through nine; scores were then averaged to determine an overall readiness score for each community. A thematic analysis of interview responses aided in interpretation of the readiness scores and identified areas for prevention planning and intervention development. RESULTS The overall community readiness score for the communities was 2.9 (SD = 0.5), which falls between 2 (denial/resistance) and 3 (vague awareness) on the anchored rating scale. The thematic analysis resulted in a hierarchal classification scheme with six broad themes that corresponded to the CRM dimensions and 13 sub-themes. DISCUSSION The low readiness scores directed the team to implement corresponding strategies to increase awareness, while the thematic analysis suggested that action-based approaches might also be appropriate. The narrow range of scores suggest that community-wide assessments may be sufficient unless specific information is needed for each region of the community. The CRM may be an effective way to assess community readiness to address childhood obesity on an American Indian Reservation.
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Affiliation(s)
- Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Blakely Brown
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Lindsey Shankle
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code L222, Portland, OR, 97239, USA
| | - Michael Tryon
- Summit Medical Fitness Center, 205 Sunnyview Lane, Kalispell, MT, 59901, USA
| | - Maja Pedersen
- School of Public and Community Health Sciences, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | | | - Gyda Swaney
- Department of Psychology, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
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Pradeilles R, Marr C, Laar A, Holdsworth M, Zotor F, Tandoh A, Klomegah S, Coleman N, Bash K, Green M, Griffiths PL. How ready are communities to implement actions to improve diets of adolescent girls and women in urban Ghana? BMC Public Health 2019; 19:646. [PMID: 31138180 PMCID: PMC6537223 DOI: 10.1186/s12889-019-6989-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 05/15/2019] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Rebecca Pradeilles
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK.
| | - Colette Marr
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - Amos Laar
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Michelle Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - Francis Zotor
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Akua Tandoh
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Senam Klomegah
- Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
| | - Nathaniel Coleman
- Department of Population, Family & Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kristin Bash
- Public Health Section, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, UK
| | - Mark Green
- School of Environmental Sciences, University of Liverpool, Liverpool, UK
| | - Paula L Griffiths
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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Kostadinov I, Daniel M, Jones M, Cargo M. Assessing change in perceived community leadership readiness in the Obesity Prevention and Lifestyle program. Health Promot J Austr 2018; 27:208-214. [PMID: 27692062 DOI: 10.1071/he16050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed The context of community-based childhood obesity prevention programs can influence the effects of these intervention programs. Leadership readiness for community mobilisation for childhood obesity prevention is one such contextual factor. This study assessed perceived community leadership readiness (PCLR) at two time points in a state-wide, multisite community-based childhood obesity prevention program. Methods PCLR was assessed across 168 suburbs of 20 intervention communities participating in South Australia's Obesity Prevention and Lifestyle (OPAL) program. Using a validated online PCLR tool, four key respondents from each community rated each suburb within their respective community on a nine-point scale for baseline and 2015. Average PCLR and change scores were calculated using the general linear model with suburbs nested in communities. Relationships between demographic variables and change in PCLR were evaluated using multiple regression. Ease of survey use was also assessed. Results Average PCLR increased between baseline (3.51, s.d.=0.82) and 2015 (5.23, s.d.=0.89). PCLR rose in 18 of 20 intervention communities. PCLR was inversely associated with suburb population size (r2=0.03, P=0.03, β=-0.25) and positively associated with intervention duration (r2 change=0.08, P=0.00, β=0.29). Only 8% of survey respondents considered the online assessment tool difficult to use. Conclusions PCLR increased over the course of the OPAL intervention. PCLR varied between and within communities. Online assessment of PCLR has utility for multisite program evaluations. So what? Use of a novel, resource-efficient online tool to measure the key contextual factors of PCLR has enabled a better understanding of the success and generalisability of the OPAL program.
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Affiliation(s)
- Iordan Kostadinov
- Centre for Population Health Research, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, GPO Box 2471, North Terrace, Adelaide, SA 5001, Australia
| | - Mark Daniel
- Centre for Population Health Research, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, GPO Box 2471, North Terrace, Adelaide, SA 5001, Australia
| | - Michelle Jones
- Centre for Population Health Research, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, GPO Box 2471, North Terrace, Adelaide, SA 5001, Australia
| | - Margaret Cargo
- Centre for Population Health Research, Sansom Institute for Health Research, School of Health Sciences, University of South Australia, GPO Box 2471, North Terrace, Adelaide, SA 5001, Australia
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