Process evaluation of a community-based adolescent obesity prevention project in Tonga

<b>Background:</b> The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma&rsquo;alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention.<br /><b>Methods:</b> MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models.<br /><b>Results:</b> While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns.<br /><b>Conclusions:</b> The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity.<br />

Policy and prevention : alcohol industry and non alcohol industry sponsorship of sportspeople and drinking

<b>Aims:</b> To examine the relationship between direct alcohol and non-alcohol sponsorship and drinking in Australian sportspeople. <br /><b>Methods:</b> Australian sportspeople (N = 652; 51% female) completed questionnaires on alcohol and non-alcohol industry sponsorship (from bars, cafes etc.), drinking behaviour (Alcohol Use Disorders Identification Test (AUDIT)) and known confounders.<br /> <b>Results:</b> 31% reported sponsorship (29.8% alcohol industry; 3.7% both alcohol and non-alcohol industry and 1.5% non-alcohol industry only) Multivariate regression showed that receipt of alcohol industry sponsorship was predictive of higher AUDIT scores (&beta;adj = 1.67, 95% confidence interval (CI ): 0.56&ndash;2.78), but non-alcohol industry sponsorship and combinations of both were not (&beta;adj = 0.18, 95% CI: &minus;2.61 to 2.68; and &beta;adj = 2.58, 95% CI: &minus;0.60 to 5.76, respectively). <br /><b>Conclusion:</b> Governments should consider alternatives to alcohol industry sponsorship of sport. Hypothecated taxes on tobacco have been used successfully for replacing tobacco sponsorship of sport in some countries, and may show equal utility for the alcohol industry&rsquo;s funding of sport.<br />

Nutrient profiling interventions targeting obesity prevention : role and potential impact

This thesis outlined the role and potential impact of a range of policy options for obesity prevention. It provided evidence that population-wide interventions, such as changes to food labelling and taxes on unhealthy foods, are likely to offer excellent 'value for money' for governments from an obesity prevention perspective.

Best practice principles for community-based obesity prevention : development, content and application

Best practice in obesity prevention has generally been defined in terms of &lsquo;what&rsquo; needs to be done while neglecting &lsquo;how&rsquo;. A multifaceted definition of best practice, which combines available evidence on what actions to take, with an established process for interpreting this information in a specific community context, provides a more appropriate basis for defining the principles of best practice in community-based obesity prevention. Based on analysis of a range of literature, a preliminary set of principles was drafted and progressively revised through further analyses of published literature and a series of consultations. The framework for best practice principles comprises: community engagement, programme design and planning, evaluation, implementation and sustainability, and governance. Specific principles were formulated within this framework. While many principles were generic, distinctive features of obesity prevention were also covered. The engagement of end-users influenced the design of the formatting of the outputs, which represent three levels of knowledge transfer: detailed evidence summaries, guiding questions for programme planners and a briefer set of questions for simpler communication purposes. The best practice principles provide a valuable mechanism for the translation of existing evidence and experience into the decision-making processes for planning, implementing and evaluating the complex community-based interventions needed for successful obesity prevention.<br />

Implementation of diabetes prevention programs in rural areas : Montana and south-eastern Australia compared

<b>Objective:</b> To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.<br /><b>Methods:</b> Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators&rsquo; experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.<br /><b>Results:</b> Four main themes emerged from the focus groups: establishing and implementing the diabetes prevention program in the community; strategies for recruitment and retention of participants; what works in lifestyle intervention programs; and rural-centred issues.<br /><b>Conclusions:</b> The results from this study have assisted in determining the factors that contribute to developing, establishing and implementing successful diabetes prevention programs in two rural areas. Recommendations to increase the likelihood of success of programs in rural communities include: securing funding early for the program; establishing support from community leaders and developing positive relationships with health care providers; creating a professional team with passion for the program; encouraging participants to celebrate their small and big successes; and developing procedures for providing post-intervention support to help participants maintain their success.<br /><br />

The spread and uptake of diabetes prevention programs around the world : a case study from Finland and Australia

Type 2 diabetes is a major public health issue in most countries around the world. Efficacy trials have demonstrated that lifestyle modification programs can significantly reduce the risk of type 2 diabetes. Two key challenges are: [1] to develop programs that are more feasible for &ldquo;real world&rdquo; implementation and [2] to extend the global reach of such programs, particularly to resource-poor countries where the burden of diabetes is substantial. This paper describes the development, implementation, and evaluation of such &ldquo;real world&rdquo; programs in Finland and Australia, the exchange between the two countries, and the wider uptake of such programs. Drawing on the lessons from these linked case studies, we discuss the implications for improving the &ldquo;spread&rdquo; of diabetes prevention programs by more effective uptake of lifestyle change programs and related strategies for more resource-poor countries and settings.<br />

Life! in Australia : translating prevention research into a large-scale intervention

The increasing prevalence of type 2 diabetes is of great public health concern. In the state of Victoria, Australia, a group-based lifestyle intervention programme, Life! &ndash; Taking Action on Diabetes, was developed for people over the age of 50 years who are at high risk of diabetes. It aims to reduce the risk of diabetes by providing practical skills, including goal setting and problem solving, to encourage participants to adopt a healthy diet and active lifestyle. The programme is delivered by specially trained facilitators who have undergone an accredited three-stage training programme. A quality assurance process is also in place to ensure that it is delivered to a consistently high standard. The Life! program<br />is a direct progression from the Finnish randomised controlled trial and the Greater Green Triangle Diabetes Prevention Project implementation trial. This paper describes how a diabetes prevention programme was implemented at a state-wide level and the training of facilitators to conduct the group sessions. Future studies are needed to examine the cost effectiveness and development of specific programmes for diverse population groups.<br />

Parent–child interactions and obesity prevention : a systematic review of the literature

Child obesity research has generally not examined multiple layers of parent&ndash;child relationships during weight-related activities such as feeding, eating and play. A literature review was conducted to locate empirical studies that measured parent&ndash; child interactions and child eating and child weight variables; five papers met the inclusion criteria and were included in the review. The findings of the review revealed that parent&ndash;child relationships are an important element in explaining the unhealthy trend of childhood obesity. We argue that prevention/intervention strategies must extend on the current models of parenting by targeting the family from a bi-directional perspective, and focusing, specifically, on the mutually responsive orientation that exists in the parent&ndash;child relationship.<br />

Parental influence and obesity prevention in pre-schoolers : a systematic review of interventions

Obesity is difficult to reverse in older children and adults and calls have been made to implement obesity prevention strategies during the formative pre-school years. Childhood obesity experts suggest that prevention of overweight in the pre-school years should focus on parents, because parental beliefs, attitudes, perceptions and behaviours appear to contribute to children&rsquo;s development of excessive weight gain. While evidence suggests that parental variables may be instrumental in the development of obesity, there has been no systematic evaluation of whether intervening to change such variables will positively influence the development of excess adiposity during the pre-school years. This paper is a conceptual and methodological review of the literature on the parental variables targeted in interventions designed to modify risk factors for obesity by promoting healthy eating and/or physical activity and/or reducing sedentary behaviours in families of children aged 2&ndash;6 years. There were significant methodological limitations of existing studies and the scientific study of this area is in its infancy. However, the results suggest that the modification of parental variables known to be associated with obesity-promoting behaviours in pre-school children may show promise as an obesity prevention strategy; further research is needed.<br />

The role of policy in improving diets : experiences from the Pacific obesity prevention in communities food policy project

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation.<br />