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Wheaton N, Alston E, Versace VL, Field M, Wong Shee A, Jacobs J, Backholer K, Allender S, Nichols M, Needham C, Bolton KA, Blake MR, Stewart F, Close E, Alston L. Diet-Related Disease Prevention in a Rural Australian Setting: Understanding Barriers, Enablers, and the Role of Rural Health Services in Supporting Changes in Local Rural Food Environments. Nutrients 2023; 15:4979. [PMID: 38068837 PMCID: PMC10708407 DOI: 10.3390/nu15234979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
Bold and comprehensive action is needed to prevent diet-related diseases in rural areas, which includes improving food environments to enable healthier dietary practices. Rural health services are integral to the health of rural populations, yet their role in community disease prevention is not swell understood. This study sought to understand health service, local government, and food outlet stakeholders' perspectives on (1) the drivers of unhealthy retail environments in a rural setting; (2) the role of rural health services in supporting changes in local food environments; and to (3) identify characteristics of potential interventions. Two Group Model Building workshops were held with health service and local government leaders (n = 9), and interviews were conducted with local food outlet participants (n = 13). Key themes included 'enablers to healthier food environments', 'barriers to healthier food environments', 'Rural health services are a leading broker of knowledge for healthy food environments', and 'characteristics of desirable healthy food environment interventions.'. Rural health services can play a key role in addressing the current barriers to healthy food environments in rural areas. Effective promotion of healthier diets in rural populations will require consideration of key stakeholder perspectives and the development of further evidence on the role that rural health services can play in improving the healthiness of food environments.
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Affiliation(s)
- Nikita Wheaton
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
| | - Emily Alston
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Vincent L. Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
| | - Michael Field
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
- Grampians Health, Ballarat, VIC 3350, Australia
| | - Jane Jacobs
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Kathryn Backholer
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Cindy Needham
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Kristy A. Bolton
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia
| | - Miranda R. Blake
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC 3220, Australia; (J.J.); (K.B.); (S.A.); (M.N.); (C.N.); (K.A.B.); (M.R.B.)
| | - Fletcher Stewart
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Evelyn Close
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Warnambool, VIC 3284, Australia; (V.L.V.); (M.F.); (A.W.S.); (L.A.)
- Research Unit, Colac Area Health, Colac, VIC 3250, Australia; (E.A.); (F.S.); (E.C.)
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Li B, He Z, Peters R, Allender S, Zou Y, Zhou W, Lao J, Poh BK, Swinburn B. Cultural adaptations and methodological innovations to group model building for the systems actions to reduce malnutrition in all its forms in Southeast Asian countries and China (SYSTAM CHINA-SEACS International Consortium) project. Int J Behav Nutr Phys Act 2023; 20:111. [PMID: 37723534 PMCID: PMC10506199 DOI: 10.1186/s12966-023-01510-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Group Model Building (GMB) is a participatory system dynamics method increasingly used to address complex public health issues like obesity. GMB represents a set of well-defined steps to engage key stakeholders to identify shared drivers and solutions of a given problem. However, GMB has not yet been applied specifically to develop multi-duty interventions that address multiple inter-related issues such as malnutrition in all its forms (MIAIF). Moreover, a recent systematic review of empirical applications of a systems approach to developing obesity interventions found no published work from non-western, low- and middle-income countries (LMICs). In this paper we describe adaptations and innovations to a common GMB process to co-develop systemic MIAIF interventions with Chinese decision-makers. METHODS We developed, piloted and implemented multiple cultural adaptations and two methodological innovations to the commonly used GMB process in Fang Cheng Gang city, China. We included formal, ceremonial and policy maker engagement events before and between GMB workshops, and incorporated culturally tailored arrangements during participant recruitment (officials of the same seniority level joined the same workshop) and workshop activities (e.g., use of individual scoring activities and hand boards). We made changes to the commonly used GMB activities which enabled mapping of shared drivers of multiple health issues (in our case MIAIF) in a single causal loop diagram. We developed and used a 'hybrid' GMB format combining online and in person facilitation to reduce travel and associated climate impact. RESULTS Our innovative GMB process led to high engagement and support from decision-makers representing diverse governmental departments across the whole food systems. We co-identified and prioritised systemic drivers and intervention themes of MIAIF. The city government established an official Local Action Group for long-term, inter-departmental implementation, monitoring and evaluation of the co-developed interventions. The 'hybrid' GMB format enabled great interactions while reducing international travel and mitigating limitations of fully online GMB process. CONCLUSIONS Cultural and methodological adaptations to the common GMB process for an Asian LMIC setting were successful. The 'hybrid' GMB format is feasible, cost-effective, and more environmentally friendly. These cultural adaptations could be considered for other Asian settings and beyond to address inter-related, complex issues such as MIAIF.
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Affiliation(s)
- Bai Li
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK.
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Zouyan He
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Remco Peters
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Yunfeng Zou
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China.
| | - Weiwen Zhou
- Institute of Nutrition and School Health, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, Guangxi, China
| | - Jianfeng Lao
- Fang Cheng Gang Health Commission, Fangchenggang, Guangxi, China
| | - Bee Koon Poh
- Centre for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
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