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Muellmann S, Gansefort D, Zeeb H, Brand T. Addressing community readiness to promote physical activity in older adults in Germany. Health Promot Int 2023; 38:daad158. [PMID: 38011398 DOI: 10.1093/heapro/daad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Community-based approaches are promising to promote physical activity in old age. The community readiness (CR) model offers a structured approach to assess community capacities to address a certain health topic before and after implementing an intervention. The objective of this study is to assess whether community-based capacity building for physical activity among the elderly has a lasting effect on CR. Four communities (two sub-urban and two urban) in Northwestern Germany were randomly assigned to either intervention or control group. CR was assessed at three time points (2015, 2018 and 2020) by interviewing local key informants (n = 129). Community capacity building was carried out in the two intervention communities after baseline assessment and included the development and implementation of a local physical activity action plan for elderly. Overall CR scores were calculated and random effects regression analysis was performed to analyze group-by-time interaction. At baseline, the overall CR score was 4.62 (standard deviation (SD) = 0.51) indicating that communities were in the preplanning stage of CR. CR scores in the intervention communities did not significantly increase at follow-up assessments compared to control communities [2018: 4.82, coefficient -0.03, 95% confidence interval (CI) (-0.80; 0.73); 2020: 4.54, coefficient 0.19, 95% CI: (-0.59; 0.97)]. The process evaluation indicated several factors facilitating a successful cooperation with community stakeholders. These included building on existing networks, using a structured approach for developing and implementing a local physical activity action plan for older adults, providing financial support for implementing activities and linking activities to existing community events.
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Affiliation(s)
- Saskia Muellmann
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
| | - Dirk Gansefort
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
- Association for Health Promotion and Academy for Social Medicine Lower Saxony Bremen, Fenskenweg 2, 30165 Hannover, Germany
| | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, Grazer Str. 4, 28359 Bremen, Germany
| | - Tilman Brand
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
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Whelan J, Brimblecombe J, Christian M, Vargas C, Ferguson M, McMahon E, Lee A, Bell C, Boelsen-Robinson T, Blake MR, Lewis M, Alston L, Allender S. CO-Creation and Evaluation of Food Environments to Advance Community Health (COACH). AJPM FOCUS 2023; 2:100111. [PMID: 37790671 PMCID: PMC10546519 DOI: 10.1016/j.focus.2023.100111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Food environments are a key determinant of food intake and diet-related health. This paper describes the development of an iterative, adaptive, context-specific framework for health-enabling food environments embedded in cocreation theory. Methods A 3-stage multimethod framework for the coproduction and prototyping of public health interventions was followed in an iterative manner during the development of the framework. These 3 stages were (1) evidence review, including systematic review, consultation with experts, and observation of current work; (2) codesign of the framework prototype with multiple stakeholders; and (3) coproduction through refinement of the prototype through stakeholder workshops and expert reviews with incorporation of researcher notes and workshop evaluation. We use the term prototype during the development phase and the term framework to report on the final product. Results COACH (CO-creation and evaluation of food environments to Advance Community Health) is a process framework that describes what best practice application of cocreation in health-enabling food retail environments should involve. COACH consists of 10 interdependent factors within a 4-phase continuous quality improvement cycle. The 4 phases of the cycle are engagement and governance establishment, communication and policy alignment, codesign and implementation, and monitoring and evaluation. Conclusions Utilizing cocreation theory represents an innovative step in research and practice to improve the healthiness of food retail environments. COACH provides a specific, unique, and comprehensive guide to the utilization of cocreation to improve the healthiness of food environments in practice.
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Affiliation(s)
- Jillian Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Medicine, Deakin University, Geelong, Australia
| | - Julie Brimblecombe
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Science, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Meaghan Christian
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Science, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Carmen Vargas
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Megan Ferguson
- School of Public Health, The University of Queensland, Brisbane, Australia
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - Emma McMahon
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Darwin, Australia
| | - Amanda Lee
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Medicine, Deakin University, Geelong, Australia
| | - Tara Boelsen-Robinson
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Miranda R. Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Meron Lewis
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Laura Alston
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute of Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
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Li B, Alharbi M, Allender S, Swinburn B, Peters R, Foster C. Comprehensive application of a systems approach to obesity prevention: a scoping review of empirical evidence. Front Public Health 2023; 11:1015492. [PMID: 37614454 PMCID: PMC10442543 DOI: 10.3389/fpubh.2023.1015492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 06/12/2023] [Indexed: 08/25/2023] Open
Abstract
A systems approach to obesity prevention is increasingly urged. However, confusion exists on what a systems approach entails in practice, and the empirical evidence on this new approach is unclear. This scoping review aimed to identify and synthesise studies/programmes that have comprehensively applied a systems approach to obesity prevention in intervention development, delivery/implementation, and evaluation. By searching international databases and grey literature, only three studies (10 publications) met inclusion criteria, which might be explained partially by suboptimal reporting. No conclusion on the effectiveness of this approach can be drawn yet due to the limited evidence base. We identified common features shared by the included studies, such as measuring ongoing changes, in addition to endpoint outcomes, and supporting capacity building. Some facilitators and barriers to applying a comprehensive systems approach in practice were identified. More well-designed and reported studies are needed, especially from low- and middle-income countries.
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Affiliation(s)
- Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Mohammed Alharbi
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Steve Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
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Niknam M, Omidvar N, Eini-Zinab H, Kalantari N, Olazadeh K, Amiri P. Improving community readiness among Iranian local communities to prevent childhood obesity. BMC Public Health 2023; 23:344. [PMID: 36793004 PMCID: PMC9931445 DOI: 10.1186/s12889-023-15163-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
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.
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Affiliation(s)
- Mahdieh Niknam
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran.
| | - Hassan Eini-Zinab
- grid.411600.2Department of Community Nutrition, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran
| | - Naser Kalantari
- grid.411600.2Department of Community Nutrition, National Nutrition and Food Technology Research Institute (NNFTRI), Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan, St. Farahzadi Blvd., Shahrak Qods, Tehran, Iran
| | - Keyvan Olazadeh
- grid.411600.2Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran.
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Williams T, Thompson K, Brown C, Hammond M, Cargo M, Murtha K. 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. Health Promot J Austr 2023; 34:30-40. [PMID: 35841136 DOI: 10.1002/hpja.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/23/2022] [Accepted: 07/02/2022] [Indexed: 01/27/2023] Open
Abstract
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.
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Affiliation(s)
- Tiffany Williams
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Kani Thompson
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Clare Brown
- Apunipima Cape York Health Council, Bungalow, Queensland, Australia
| | - Melinda Hammond
- Northern Queensland Primary Health Network, Cairns, Queensland, Australia
| | - Margaret Cargo
- University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Kirby Murtha
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northwest Territories, Australia
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Whelan J, Love P, Aitken J, Millar L, Morley C, Melgren N, Allender S, Bell C. A mixed-methods evaluation of a health-promoting café located in a small health service in rural Victoria, Australia. Aust J Rural Health 2023; 31:61-69. [PMID: 35894288 PMCID: PMC10946910 DOI: 10.1111/ajr.12901] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Residents of rural areas internationally typically experience chronic disease risk profiles worse than city dwellers. Poor diet, a key driver of chronic disease, has been associated with unhealthy food environments, and rural areas often experience limited access to healthy, fresh and affordable food. OBJECTIVE This study aimed to evaluate the first three years of a health promoting social enterprise café established in a small rural health service. DESIGN A mixed-methods evaluation study. Quantitative sales data, surveys and key informant interviews that included both quantitative and qualitative responses. FINDINGS Three years of sales data were included; 111customer surveys and five key informant interviews were conducted. Food and beverages on displayed and sold consistently met or exceeded the healthy criteria set by policy. Stakeholders supported the traffic light system, the social enterprise model and rated the likelihood of sustainability of the café as high. DISCUSSION Customers used the 'traffic light' system to inform food choices, placed value on the warmth of the staff and on the welcoming environment created through the social enterprise model. Resources remain tight although all stakeholders are committed to the sustainability of the YarriYak café. CONCLUSION The study shows the acceptability, feasibility and sustainability of a health promoting social enterprise café in a rural area.
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, School of Medicine, Global Obesity CentreDeakin UniversityGeelongAustralia
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongAustralia
| | - John Aitken
- LaTrobe Rural Health SchoolLa Trobe UniversityBendigoAustralia
| | - Lynne Millar
- Telethon Kids InstituteNedlandsWestern AustraliaAustralia
- School of Population HealthCurtin UniversityBentleyWestern AustraliaAustralia
| | | | - Ngareta Melgren
- Rural Northwest Health ServiceWarracknabealVictoriaAustralia
| | - Steven Allender
- Institute of Health Transformation, School of Health and Social Development, Global Obesity CentreDeakin UniversityGeelongVictoriaAustralia
| | - Colin Bell
- Institute for Health Transformation, School of Medicine, Global Obesity CentreDeakin UniversityGeelongAustralia
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Niknam M, Omidvar N, Amiri P, Eini-Zinab H, kalantari N. Adapting the Community Readiness Model and Validating a Community Readiness Tool for Childhood Obesity Prevention Programs in Iran. J Prev Med Public Health 2023; 56:77-87. [PMID: 36746425 PMCID: PMC9925285 DOI: 10.3961/jpmph.22.409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Mahdieh Niknam
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author: Nasrin Omidvar, Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan Street, Shahrak Qods, Tehran 1981629573, Iran E-mail:
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Co-corresponding author: Parisa Amiri, Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak Street, Shahid Chamran Highway, Tehran 1985717413, Iran E-mail:
| | - Hassan Eini-Zinab
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Fraser P, Whelan JM, Brown AD, Allender SE, Bell C, Bolton KA. System approaches to childhood obesity prevention: ground up experience of adaptation and real-world context. Public Health Nutr 2022; 26:1-4. [PMID: 36468439 PMCID: PMC10131143 DOI: 10.1017/s1368980022002531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention. DESIGN We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens. SETTING Communities. PARTICIPANTS Practice-based researcher experience and perspectives. RESULTS Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded. CONCLUSIONS We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.
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Affiliation(s)
- Penny Fraser
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Medicine, Deakin University, 1 Gheringhap St, Geelong, VIC, Australia
| | - Jillian M Whelan
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Medicine, Deakin University, 1 Gheringhap St, Geelong, VIC, Australia
| | - Andrew D Brown
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Steven E Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Colin Bell
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Medicine, Deakin University, 1 Gheringhap St, Geelong, VIC, Australia
| | - Kristy A Bolton
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
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Love P, Laws R, Taki S, West M, Hesketh KD, Campbell KJ. Factors contributing to the sustained implementation of an early childhood obesity prevention intervention: The INFANT Program. FRONTIERS IN HEALTH SERVICES 2022; 2:1031628. [PMID: 36925886 PMCID: PMC10012774 DOI: 10.3389/frhs.2022.1031628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
Background The INFANT Program is an efficacious, group-based program for first-time parents, delivered at three-monthly intervals when INFANT are aged 3-18 months through an existing universal care service in Victoria, Australia. Many lessons have been learnt from its origins as a cluster randomized control trial to its small-scale, community-level implementation. This study aimed to describe factors contributing to its sustained implementation to inform large-scale implementation across Australia. Methods This study used a multi-site qualitative exploratory approach. INFANT facilitators trained between 2013 and 2017 were sent an online survey, with optional telephone interviews. The Consolidated Framework for Implementation Research (CFIR) was selected as the underpinning theoretical framework as it offered the opportunity to explore a breadth of possible barriers and enablers across patterns of implementation (never, discontinued, ongoing). Results All participants were female (n = 31), the majority were Maternal and Child Health Nurses (48%), representing five regional and nine metro local government areas (LGAs), across all patterns of implementation (never implemented n = 4; discontinued implementation n = 5; ongoing implementation n = 5). All consenting participants were interviewed (n = 11) representing four regional and seven metro LGAs, across all patterns of implementation (never implemented n = 3; discontinued implementation n = 4; ongoing implementation n = 4). The main reason for attending INFANT Program training was to become skilled to implement the program. Mapping identified barriers and enablers to the CFIR revealed the inner and outer settings and implementation process to be of greatest influence. Main differences between LGAs with ongoing and discontinued implementation related to funding availability, organizational management support and endorsement, organizational resourcing and capacity, integration into routine practice and establishing role clarity with partner organizations, and planning for sustained implementation from the start. Conclusion This study provides important insights into the barriers and enablers to the sustained implementation of an evidence-based intervention (the INFANT Program) during small scale community-level implementation. The authors therefore contend that the pre-requisite for scale-up of a population health intervention is not just proof of effectiveness but also proof of sustained implementation at the local/organizational level. Study findings have broad transferability given their similarity to those identified for health promotion interventions implemented globally, in healthcare, education and community settings.
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Affiliation(s)
- Penelope Love
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Rachel Laws
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Sarah Taki
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
| | - Madeline West
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Karen J. Campbell
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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Nau T, Bauman A, Smith BJ, Bellew W. A scoping review of systems approaches for increasing physical activity in populations. Health Res Policy Syst 2022; 20:104. [PMID: 36175916 PMCID: PMC9524093 DOI: 10.1186/s12961-022-00906-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/02/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction The past decade has increasingly seen systems approaches as a featured theme in public health studies and policy documents. This trend is evident in the area of physical activity, which is a significant global health risk factor that is addressed in WHO’s Global Action Plan on Physical Activity. We undertook a comprehensive scoping review to characterize the application of systems approaches to physical activity, to develop a typology of the objectives, themes and methods of research papers that purported to apply systems thinking to this issue. Methods We searched electronic databases (PubMed, Web of Science, Scopus and PsycINFO) for studies published during the period 2010–2021 that explicitly applied systems approaches or methods to investigate and/or address population physical activity. A framework using systems-based methodological approaches was adapted to classify physical activity studies according to their predominant approach, covering basic descriptive, complex analytical and advanced forms of practice. We selected case studies from retained studies to depict the current “state of the art”. Results We included 155 articles in our narrative account. Literature reporting the application of systems approaches to physical activity is skewed towards basic methods and frameworks, with most attention devoted to conceptual framing and predictive modelling. There are few well-described examples of physical activity interventions which have been planned, implemented and evaluated using a systems perspective. There is some evidence of “retrofitted” complex system framing to describe programmes and interventions which were not designed as such. Discussion We propose a classification of systems-based approaches to physical activity promotion together with an explanation of the strategies encompassed. The classification is designed to stimulate debate amongst policy-makers, practitioners and researchers to inform the further implementation and evaluation of systems approaches to physical activity. Conclusion The use of systems approaches within the field of physical activity is at an early stage of development, with a preponderance of descriptive approaches and a dearth of more complex analyses. We need to see movement towards a more sophisticated research agenda spanning the development, implementation and evaluation of systems-level interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00906-2.
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Affiliation(s)
- Tracy Nau
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. .,The Australian Prevention Partnership Centre, Sydney, NSW, Australia.
| | - Adrian Bauman
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Australian Prevention Partnership Centre, Sydney, NSW, Australia
| | - Ben J Smith
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Australian Prevention Partnership Centre, Sydney, NSW, Australia
| | - William Bellew
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Australian Prevention Partnership Centre, Sydney, NSW, Australia
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11
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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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12
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Schröder M, Schnabel M, Hassel H, Babitsch B. Application of the Community Readiness Model for childhood obesity prevention: a scoping review. Health Promot Int 2022; 37:6680028. [PMID: 36047636 DOI: 10.1093/heapro/daac120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Maike Schröder
- Coburg University of Applied Sciences and Arts, Department of Holistic Health Sciences, Coburg, Germany.,Osnabrück University, Department of New Public Health, Osnabrück, Germany
| | - Monika Schnabel
- Coburg University of Applied Sciences and Arts, Department of Holistic Health Sciences, Coburg, Germany
| | - Holger Hassel
- Coburg University of Applied Sciences and Arts, Department of Holistic Health Sciences, Coburg, Germany
| | - Birgit Babitsch
- Osnabrück University, Department of New Public Health, Osnabrück, Germany
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13
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Esdaile EK, Gillespie J, Baur LA, Wen LM, Rissel C. Australian State and Territory Eclectic Approaches to Obesity Prevention in the Early Years: Policy Mapping and Perspectives of Senior Health Officials. Front Public Health 2022; 10:781801. [PMID: 35719604 PMCID: PMC9204007 DOI: 10.3389/fpubh.2022.781801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The international increase in the prevalence of childhood obesity has hastened in recent decades. This rise has coincided with the emergence of comorbidities in childhood-such as type II diabetes, non-alcoholic fatty liver disease, metabolic syndrome, sleep apnoea and hypertension-formerly only described in adulthood. This phenomenon suggests global social and economic trends are impacting on health supportive environments. Obesity prevention is complex and necessitates both long-term and systems approaches. Such an approach considers the determinants of health and how they interrelate to one another. Investment in the early years (from conception to about 5 years of age) is a key life stage to prevent obesity and establish lifelong healthy habits relating to nutrition, physical activity, sedentary behavior and sleep. In Australia, obesity prevention efforts are spread across national and state/territory health departments. It is not known from the literature how, with limited national oversight, state and territory health departments approach obesity prevention in the early years. Methods We conducted a qualitative study including policy mapping and interviews with senior officials from each Australian state/territory health department. A series of questions were developed from the literature to guide the policy mapping, drawing on the World Health Organisation Ending Childhood Obesity Report, and adapted to the state/territory context. The policy mapping was iterative. Prior to the interviews initial policy mapping was undertaken. During the interviews, these policies were discussed, and participants were asked to supply any additional policies of relevance to obesity prevention. The semi-structured interviews explored the approaches to obesity prevention taken in each jurisdiction and the barriers and enablers faced for policy implementation. Thematic analysis was used to analyse the data, using NVivo software. Results State and territory approaches to obesity prevention are eclectic and while there are numerous similarities between jurisdictions, no two states are the same. The diversity of approaches between jurisdictions is influenced by the policy culture and unique social, geographic, and funding contexts in each jurisdiction. No Australian state/territory had policies against all the guiding questions. However, there are opportunities for sharing and collaborating within and between Australian jurisdictions to establish what works, where, and for whom, across Australia's complex policy landscape. Conclusions Even within a single country, obesity prevention policy needs to be adaptable to local contexts. Opportunities for jurisdictions within and between countries to share, learn, and adapt their experiences should be supported and sustained funding provided.
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Affiliation(s)
- Emma K. Esdaile
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Prevention Research Collaboration, Faculty of Health and Medicine, Charles Perkins Centre, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- The Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - James Gillespie
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Louise A. Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Prevention Research Collaboration, Faculty of Health and Medicine, Charles Perkins Centre, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- The Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
- Specialty of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Prevention Research Collaboration, Faculty of Health and Medicine, Charles Perkins Centre, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- The Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Prevention Research Collaboration, Faculty of Health and Medicine, Charles Perkins Centre, School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- The Centre for Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
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14
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A Theory of Change for Community-Based Systems Interventions to Prevent Obesity. Am J Prev Med 2022; 62:786-794. [PMID: 34865936 DOI: 10.1016/j.amepre.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/27/2021] [Accepted: 10/19/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Applying systems science in public health trials is a recent innovation in childhood obesity prevention. This paper aims to use systems science conventions to propose a theory of change for community-based interventions aiming to build capacity and use exemplars from systems science for obesity prevention to describe how this approach works. METHODS Participants were community-based researchers. A dynamic hypothesis was created in workshops conducted in 2020 and 2021 by identifying variables critical to building community capacity for systems thinking. These were used to develop stock and flow diagrams representing individual causal relationships, feedback loops, and the overall theory of change. RESULTS The resultant model identified 9 stocks and 4 pairs of central balancing and reinforcing feedback loops. These represented building commitment through relationships, mutual learning, strengthening collaboration, and embedding capacity. The model is described using examples from 3 trials involving 25 communities across Victoria, Australia. CONCLUSIONS This nonlinear and practice-based model illustrates the process of community-based obesity prevention. The model integrates >20 years of community-based intervention implementation experience, providing an overarching theory of how such interventions work to create change and prevent obesity.
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15
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Bolton KA, Whelan J, Fraser P, Bell C, Allender S, Brown AD. The Public Health 12 framework: interpreting the 'Meadows 12 places to act in a system' for use in public health. Arch Public Health 2022; 80:72. [PMID: 35255970 PMCID: PMC8900091 DOI: 10.1186/s13690-022-00835-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Systems science approaches have demonstrated effectiveness in identifying underlying drivers of complex problems and facilitating the emergence of potential interventions that are locally tailored, feasible, sustainable and evidence informed. Despite the potential usefulness of system dynamics simulation modelling and other systems science modelling techniques in guiding implementation, time and cost constraints have limited its ability to provide strong guidance on how to implement complex interventions in communities. Guidance is required to ensure systems interventions lead to impactful systems solutions, implemented utilising strategies from the intersecting fields of systems science and implementation science. To provide cost-effective guidance on how and where to implement in systems, we offer a translation of the 'Meadows 12 places to act in a system' (Meadows 12) into language useful for public health. METHODS This translation of Meadows 12 was informed by our experience in working with 31 communities across two complex large scale randomised control trials and one large whole of community case study. These research projects utilised systems science and implementation science to co-create childhood obesity prevention interventions. The team undertaking this translation comprised research academics, implementation specialists and practitioners, practice-based researchers and a systems dynamicist. Our translation of each of the Meadows 12 levels to act in the system maintains the fidelity and nuance of the 12 distinct levels. We provide examples of each level of the Public Health 12 framework (PH12) drawn from 31 communities. All research was conducted in Victoria, Australia between 2016 and 2020. RESULTS PH12 provides a framework to guide both research and practice in real world contexts to implement targeted system level interventions. PH12 can be used with existing implementation science theory to identify relevant strategies for implementation of these interventions to impact the system at each of the leverage points. CONCLUSION To date little guidance for public health practitioners and researchers exists regarding how to implement systems change in community-led public health interventions. PH12 enables operationalisation Meadows 12 systems theory into public health interventions. PH12 can help research and practice determine where leverage can be applied in the system to optimise public health systems level interventions and identify gaps in existing efforts. TRIAL REGISTRATION WHO STOPS: ANZCTR: 12616000980437 . RESPOND ANZCTR: 12618001986268p .
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Affiliation(s)
- Kristy A Bolton
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Institute of Health Transformation, School of Health and Social Development, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Jillian Whelan
- Institute of Health Transformation, School of Medicine, Global Obesity Centre, Deakin University, Geelong, Australia.
| | - Penny Fraser
- Institute of Health Transformation, School of Health and Social Development, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute of Health Transformation, School of Medicine, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute of Health Transformation, School of Health and Social Development, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Andrew D Brown
- Institute of Health Transformation, School of Health and Social Development, Global Obesity Centre, Deakin University, Geelong, Australia
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16
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Niknam M, Omidvar N, Amiri P, Eini-Zinab H, Kalantari N. The Action Plan and Strategy Development for the Community Readiness Improvement for Tackling Childhood Obesity (CRITCO) Study. Int J Endocrinol Metab 2022; 20:e111371. [PMID: 35432551 PMCID: PMC8994822 DOI: 10.5812/ijem.111371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/09/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Community Readiness Improvement for Tackling Childhood Obesity (CRITCO) study has been developed based on the community readiness model (CRM) to improve the readiness of targeted local communities from two diverse socioeconomic districts of Tehran for tackling childhood obesity (CO) of late primary school children (10 - 12 years of age). OBJECTIVES This study aimed to describe the rationale and process of developing the fourth phase of CRITCO study by developing an intervention package. METHODS The readiness level data was used to analyze strengths, weaknesses, opportunities, and threats (SWOT) of four intervention sites to guide proper strategies in partnership with key community members. Then, the action plan was developed as a living document to guide a 6-month quasi-experimental community-based intervention around the six dimensions of CRM. Finally, the community engagement process, outcome, and evaluation process were explained. RESULTS The current report described the action plan and strategy development of the CRITCO study. Expectedly, this study can provide valuable information to guide the public health policymakers in planning and executing relevant interventions.
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Affiliation(s)
- Mahdieh Niknam
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hassan Eini-Zinab
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser Kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Muellmann S, Brand T, Jürgens D, Gansefort D, Zeeb H. How many key informants are enough? Analysing the validity of the community readiness assessment. BMC Res Notes 2021; 14:85. [PMID: 33750436 PMCID: PMC7941941 DOI: 10.1186/s13104-021-05497-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
Objective Communities are important settings for health promotion and prevention. The community readiness assessment offers a structured approach to assess resources and opportunities to tackle a health problem within a community. The assessment relies on semi-structured interviews with key informants from the communities. A number of 4–6 key informant interviews are recommended in the literature. However, it is unclear whether this is sufficient to obtain a valid representation of the respective community. This study analysed whether increasing the number of key informants from 4–6 to 12–15 alters the results of the community readiness assessment. Results A total of 55 community readiness interviews were carried out in 4 communities. Overall, the community readiness scores showed little variation after having interviewed 10 key informants in a community. However, even after completing 10 interviews in a community, key informants were still able to identify up to 6 new information items regarding community efforts for physical activity promotion among the elderly, contact and communication channel for informing or approaching the target group, or barriers to participation. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05497-9.
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Affiliation(s)
- Saskia Muellmann
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
| | - Dorothee Jürgens
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany
| | - Dirk Gansefort
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany.,Association for Health Promotion and Academy of Social Medicine Lower Saxony, Fenskenweg 2, 30165, Hannover, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr 30, 28359, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bremen, Germany.
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18
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Hayward J, Morton S, Johnstone M, Creighton D, Allender S. Tools and analytic techniques to synthesise community knowledge in CBPR using computer-mediated participatory system modelling. NPJ Digit Med 2020; 3:22. [PMID: 32133423 PMCID: PMC7031223 DOI: 10.1038/s41746-020-0230-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/24/2020] [Indexed: 11/09/2022] Open
Abstract
Participatory systems thinking methods are often used in community-based participatory research to engage and respond to complexity. Participation in systems thinking activities creates opportunities for participants to gain useful insights about complexity. It is desirable to design activities that extend the benefits of this participation into communities, as these insights are predictive of success in community-based prevention. This study tests an online, computer-mediated participatory system modelling platform (STICKE) and associated methods for collating and analysing its outputs. STICKE was trialled among a group of community members to test a computer-mediated system modelling exercise. The causal diagrams resulting from the exercise were then merged, and network analysis and DEMATEL methods applied to inform the generation of a smaller summary model to communicate insights from the participant group as a whole. Participants successfully completed the online modelling activity, and created causal diagrams consistent with expectations. The DEMATEL analysis was identified as the participant-preferred method for converging individuals causal diagrams into a coherent and useful summary. STICKE is an accessible tool that enabled participants to create causal diagrams online. Methods trialled in this study provide a protocol for combining and summarising individual causal diagrams that was perceived to be useful by the participant group. STICKE supports communities to consider and respond to complex problems at a local level, which is cornerstone of sustainable effective prevention. Understanding how communities perceive their own health challenges will be important to better support and inform locally owned prevention efforts.
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Affiliation(s)
- Joshua Hayward
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, 3220 Australia
| | - Saraya Morton
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, 3220 Australia
| | - Michael Johnstone
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Australia
| | - Doug Creighton
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, 3220 Australia
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