Translating a whole of system approach to an urban community setting: a realist evaluation

Introduction

The recent Lancet Commissions report on The Global Syndemic of Obesity, Undernutrition, and Climate Change highlights the need for comprehensive actions to address the global epidemic of obesity. The Campbelltown - Changing our Future project utilised a community led participatory systems mapping approach to develop interventions to address childhood obesity in an urban environment. While there is evidence demonstrating the impact of systems approaches on outcomes, there is limited examples internationally demonstrating what works in which circumstances, for whom and most importantly how.

Methods

A realist evaluation framework was used by project staff to identify key mechanisms that enabled project outcomes. This framework uses four key interrelated concepts: “mechanism”, “context”, “outcome pattern” and “context-mechanism-outcome (CMO) pattern configuration”. Five key underlying properties that influenced the project were analysed using the CMO pattern configuration.

Results

The five key properties that the project team has identified as key influences in the translation of a whole of system approach in an urban community are: endorsement, ways of working, deliberative learning, personality traits and partnerships. These mechanisms enabled over 90 community-led actions to be established.

Conclusions

The five properties work harmoniously together when performed in an enabling context to produce comprehensive, community-led action. Understanding “how” these theories interact and the optimal context provides opportunity for a broader understanding on the process of practical implementation of a whole of system approach.

Key messages

Provides insight into how a practical example of a whole of system approach is implemented. Endorsement, flexible ways of working, deliberative learning, personality traits and partnerships are enablers of systems based participatory approaches addressing obesity within a community setting.

An urban, community-based whole of systems approach to address childhood overweight and obesity

Background

In 2015 two billion people were estimated to be above a healthy weight globally, contributing to a rapid increase of non-communicable diseases. Evidence indicates multi-faceted and community-led interventions are most effective in addressing the complexity of childhood overweight and obesity. Campbelltown - Changing our Future is a practical example of an urban, community-based whole of system approach to identify, develop and implement community-led interventions to address this issue.

Methods

Key community stakeholders and leaders, who had power to change environments and norms, were engaged in a series of three workshops to develop a systems map. A Group Model Building (GMB) framework was used across the workshops to facilitate community perception of the key factors that compose the system that influences childhood overweight and obesity within an urban community. Community members were asked to identify and commit to community-led actions to effect change on various elements of the system.

Results

Over 200 community members were engaged in the GMB process, establishing the following systems map themes: physical activity and sedentary behaviour, healthy eating, knowledge and education and social factors. A further 200 community members are contributing to 90 ongoing community-led comprehensive interventions to address childhood overweight and obesity.

Conclusions

Over 90 actions are active within the community, ranging from high profile athletes’ role modelling reading to children through to a Council healthy food and drink policy. These actions contribute to creating change across multiple levels of the system, an effective, sustainable solution to addressing childhood overweight and obesity.

Key messages

Practical implementation of a whole of system approach in an urban community produces community-led action. A whole of systems approach facilitates community engagement to address complex issues.

Gas Chromatographic Determination of Volatile Congeners in Spirit Drinks: Interlaboratory Study

An interlaboratory study of a gas chromatographic (GC) method for the determination of volatile congeners in spirit drinks was conducted; 31 laboratories from 8 countries took part in the study. The method uses GC with flame ionization detection and incorpo rates several quality control measures which permit the choice of chromatographic system and conditions to be selected by the user. Spirit drink samples were prepared and sent to participants as 10 blind duplicate or split-level test materials for the determination of 1,1-diethoxyethane (acetal), 2-methylbutan-1-ol (active amyl alcohol), 3-methylbutan-1-ol (isoamyl alcohol), methanol (methyl alcohol), ethyl ethanoate (ethyl acetate), butan-1-ol (n-butanol), butan-2-ol (sec-butanol), 2-methylpropan-1-ol(isobutyl alcohol), propan-1-ol (n-propanol), and ethanal (acetaldehyde). The precision of the method for 9 of the 10 analytes was well within the range predicted by the Horwitz equation.The precision of the most volatile analyte, ethanal, was just above statistically predicted levels. This method is recommended for official regulatory purposes.

The effects of triethyl lead on the development of hippocampal neurons in culture

Triethyl lead is the major metabolite of tetraethyl lead, which is used in industrial processes and as an antiknock additive to gasoline. We tested the hypothesis that low levels of triethyl lead (0.1 nmol/L to 5 mumol/L) interfere with the normal development of cultured E18 rat hippocampal neurons, possibly through increases in intracellular free calcium ion concentration, [Ca2+]in. The study assessed survival and differentiation using morphometric analysis of individual neurons. We also looked at short-term (up to 3.75-h) changes in intracellular calcium using the calcium-sensitive dye fura-2. Survival of neurons was significantly reduced at 5 mumol/L, and overall production of neurites was reduced at > or = 2 mumol/L. The length of axons and the number of axons and dendrites were reduced at > or = 1 mumol/L. Neurite branching was inhibited at 10 nmol/L for dendrites and 100 nmol/L for axons. Increases in intracellular calcium were observed during a 3.75-h exposure of newly plated neurons to 5 mumol/L triethyl lead. These increases were prevented by BAPTA-AM; which clamps [Ca2+]in at about 100 nmol/L. Culturing neurons with BAPTA-AM and 5 mumol/L triethyl lead did not reverse the effects of triethyl lead, suggesting that elevation of [Ca2+]in is not responsible for decreases in survival and neurite production. Triethyl lead has been shown to disrupt cytoskeletal elements, particularly neurofilaments, at very low levels, suggesting a possible mechanism for its inhibition of neurite branching at nanomolar concentrations.