Effectiveness of prevention programmes for obesity and chronic diseases amongst immigrants to developed countries - a systematic review

Objective: To determine whether interventions tailored specifically to  particular immigrant groups from developing to developed countries  decrease the risk of obesity and obesity-related diseases.

Design: Databases searched were MEDLINE (1966–September 2008), CINAHL (1982–September 2008) and PsychINFO (1960–September 2008), as well as Sociological Abstracts, PsychARTICLES, Science Direct, Web of Knowledge and Google Scholar. Studies were included if they were randomised control trials, ‘quasi-randomised’ trials or controlled before-and-after studies. Due to the heterogeneity of study characteristics only a narrative synthesis was undertaken, describing the target population, type and reported impact of the intervention and the effect size.

Results: Thirteen studies met the inclusion criteria. Ten out of thirteen (77 %) studies focused on diabetes, seven (70 %) of which showed significant improvement in addressing diabetes-related behaviours and glycaemic control. The effect on diabetes was greater in culturally tailored and facilitated interventions that encompassed multiple strategies. Six out of the thirteen studies (46 %) incorporated anthropometric data, physical activity and healthy eating as ways to minimise weight gain and diabetes-related outcomes. Of the six interventions that included anthropometric data, only two (33 %) reported improvement in BMI Z-scores, total skinfold thickness or proportion of body fat. Only one in three (33 %) of the studies that included cardiovascular risk factors reported improvement in diastolic blood pressure after adjusting for baseline characteristics. All studies, except four, were of poor quality (small sample size, poor internal consistency of scale, not controlling for baseline characteristics).

Conclusions: Due to the small number of studies included in the present review, the findings that culturally tailored and facilitated interventions produce better outcomes than generalised interventions, and that intervention content is more important than the duration or venue, require further investigation.

Evidence for healthy cities : reflections on practice, method and theory

The European Healthy Cities project can be characterized as a social movement that employs an extremely wide range of political, social and behavioural interventions for the development and sustenance of urban population health. At all of these levels, the movement is inspired by ideological, theoretical and evidence-based perspectives. The result of this stance is a dynamic, complex and diverse landscape of initiatives, plans, programmes and actions. In quantitative terms (the number of WHO designated cities and associated cities and communities through national networks), ‘Healthy Cities’ can be regarded as an extraordinary accomplishment and a credit for both WHO and cities in the movement. In qualitative terms, however, critics of the movement have maintained that little evidence on its success and effectiveness has been generated. This critique finds its foundations in the mere perceptions of evidence, the politics of science and urban governance, and perspectives on the preferred or professed utilities of evidence-based health notions. The article reviews the nature of evidence and its interface with politics and governance. Applying a conceptual framework combining insights from knowledge utilization theory, theoretical perspectives on (health) policy development, theory-based evaluations and planned intervention approaches, it demonstrates that, although the evidence is overwhelming, there are barriers to the implementation of such evidence that should be further addressed by ‘Healthy Cities’.

Effectiveness of IT-based diabetes management interventions: a review of the literature

Background : Information technology (IT) is increasingly being used in general practice to manage health care including type 2 diabetes. However, there is conflicting evidence about whether IT improves diabetes outcomes. This review of the literature about IT-based diabetes management interventions explores whether methodological issues such as sample characteristics, outcome measures, and mechanisms causing change in the outcome measures could explain some of the inconsistent findings evident in IT-based diabetes management studies.

Methods : Databases were searched using terms related to IT and diabetes management. Articles eligible for review evaluated an IT-based diabetes management intervention in general practice and were published between 1999 and 2009 inclusive in English. Studies that did not include outcome measures were excluded.

Results : Four hundred and twenty-five articles were identified, sixteen met the inclusion criteria: eleven GP focussed and five patient focused interventions were evaluated. Nine were RCTs, five non-randomised control trials, and two single-sample before and after designs. Important sample characteristics such as diabetes type, familiarity with IT, and baseline diabetes knowledge were not addressed in any of the studies reviewed. All studies used HbA1c as a primary outcome measure, and nine reported a significant improvement in mean HbA1c over the study period; only two studies reported the HbA1c assay method. Five studies measured diabetes medications and two measured psychological outcomes. Patient lifestyle variables were not included in any of the studies reviewed. IT was the intervention method considered to effect changes in the outcome measures. Only two studies mentioned alternative possible causal mechanisms.

Conclusion : Several limitations could affect the outcomes of IT-based diabetes management interventions to an unknown degree. These limitations make it difficult to attribute changes solely to such interventions.

It takes more than breadcrumbs to learn generic skills : collaborating to improve information literacy

The effective teaching and learning of generic skills is becoming an important component of undergraduate education with the introduction of graduate attribute programmes in some Australian universities. Research shows that contextualised learning of these skills is important, but is a discipline-specific context sufficient to ensure student success in acquiring these skills? This paper studies the effectiveness of information skills
learning by a group of undergraduates using Brookfield’s concept of critical reflection and Critical Incident Questionnaire (CIQ). Most students reported positive experiences where the learning environment encouraged a deep approach to learning and negative experiences where that environment encouraged a surface approach. To ensure that students’ approach to
learning is appropriate for achieving the level of information literacy required of graduates, the study recommends the integration of information skills learning into course curricula through the close collaboration of academic and library staff.

Bystander behaviour as an influence on bullying in high schools

In response to evidence that bullying in schools persists in the presence of bystanders, this study sought to add to the existing knowledge about its reinforcing effects. The objectives of this research project were to investigate non-intervention in bullying incidents by students. Unique approaches of this research are the multi-dimensional investigation of the emotional, cognitive and behavioural factors from the bystander's perspective, within the context of a co-educational Catholic high school, in a sample of eighteen Year 8 students. In-depth and group interviews, participant observation and the input of a focus group of teachers formed the data collection. Previous findings that fear prevents bystanders from taking action, were extended by this study which revealed was that there are several sources of this fear. The study found reasons for students' fear included embarrassment at making a mistake, the importance of the teachers' responses, the need to assimilate into the new school culture, to be 'cool' and to avoid a negative, conforming self-image. Importantly, the existing focus on fear does not explain why students do not anonymously report bullying. This study found that students resisted taking responsibility for intervening, and unexpected findings included that students categorised victims, only caring enough to report bullying if the victim were a friend or sibling; and also that the thrill of watching bullying was a strong deterrent to bystander intervention. The study suggests, therefore, information based anti-bullying policies will be ineffective unless students are motivated to intervene. It is crucial that programmes now address the emotional deterrents of fear, excitement and apathy before considering educational approaches, and that future policies need to examine the culture of the school, including teachers' responses to bullying, which dictates the behavioural code for incoming Year 8 students.

Empowerment in early childhood intervention : perspectives of parents of children with disabilities

There have been various changes to the manner in which early intervention services for children with disabilities have been provided in recent decades. One of the most significant paradigm shifts that has accoured pertains to a change in the level of family involvement in early intervention, so that families are now required to be equal partners with professionals in the service provision process. It is now policy in Victoria that early intervention services follow a family-centred model of practice. Services adopting this model aim to empower parents, so that they may have impact on their lives, and the lives of their family members, both during and beyond the years of direct service participation. Much of what is known about empowerment to date is based on theory, author opinion, and research that is largely survey-based. There has been little interview-based research, particulary involving parents of children with disabilities, as well as little Australian research conducted regarding empowerment. To the researcher's knowledge, there has been no interview-based research that specifically asked parents of children with disabilities about their perspectives on empowerment and disempowerment. Parents of children with disabilities are not invited to contribute their opinions in services and research. Empowerment is an individual concept and this research provided parents with an opportunity to express their views on this topic. Parent's perspectives on empowerment are vital for service providers who aim to follow the intervention model required by policy. This research, which was guided by the principles of ecological theory and critical theory, involved to individual semi-structured interviews with 37 Victorian families of children with disabilities. Twenty-one of these families had children currently participating in early intervention services, and 16 families had children of mid-primary school age, who had previously participated in early intervention experiences; the factors that they believe influence empowerment and disempowerment; and helpful and unhelpful experiences with early intervention staff and other people in their lives. Data were analysed primarily inductively, in the context of grounded theory. Responses from the two groups of parents were then compared, as were different emergent themes according to helpfulness and empowerment. The nature of enduring empowerment, one of the key objectives of early childhood intervention, was also considered. From the analysis of data, several themes emerged as influential in the empowerment process for both groups of parents including: information, education and knowledge; meeting and talking with other families of children with disabilities; decision-making and choice; having confidence; participation, involvement and input; meeting or addressing families' practical needs; and having a child with a disability. The results of this research provide valuable information for parents, professionals, agencies, organisations, and the wider community, regarding how families can be supported more effectively and how power can be more equitably balanced.

It's your move

The Its Your Move! project is a community-based intervention project focusing on the promotion of healthy eating and regular physical activity in adolescents. VHETTA, among other organisations in the community, has been invitied to have an input into the project as a consultative stakeholder. Louise Mathews is the Project Coordinnator.

The campaigns

It is arguable that the 2007 election was decided on longer term issues, and longer term campaigning. This article focuses on the campaigning side. The campaigning commenced with the election of Labor's new leadership team of Kevin Rudd and Julia Gillard in December 2006. The Howard Coalition Government, after a minor cabinet reshuffle, pressed on with the promotion of its policies and programmes; but by May 2007 was forced to change tack, making concessions on the unpopular WorkChoices policy, and then introducing a controversial Aboriginal intervention programme. The election campaign was anti-climactic. The article includes a postscript on the election aftermath, comparing Kevin Rudd with Gough Whitlam in his rapid implementation of key campaign policies.

Scales of policy intervention : problematising high poverty contexts in South Australia.

Education policy intervention for schools in high poverty neighbourhoods has focused on the capacity of local schools to make a difference and on the kinds of co-ordinated human services provision that might support individual families with “high needs”. In this paper I suggest that a more detailed analysis of “the problem” represented in such schools might yield a richer and more integrated policy approach. I use the notion of “scale”, arbitrary and imperfect approximations of spheres of activity, and apply it to a specific context in Adelaide, South Australia, to demonstrate the connections between the local school and factors which impinge on its capacities to make a positive difference. I suggest that the implication of the analysis is a more holistic approach to policy.

The process evaluation of it's your move!, an Australian adolescent community-based obesity prevention project

Background
Evidence on interventions for preventing unhealthy weight gain in adolescents is urgently needed. The aim of this paper is to describe the process evaluation for a three-year (2005-2008) project conducted in five secondary schools in the East Geelong/Bellarine region of Victoria, Australia. The project, 'It's Your Move!' aimed to reduce unhealthy weight gain by promoting healthy eating patterns, regular physical activity, healthy body weight, and body size perception amongst youth; and improve the capacity of families, schools, and community organisations to sustain the promotion of healthy eating and physical activity in the region.

Methods
The project was supported by Deakin University (training and evaluation), a Reference Committee (strategic direction, budgetary approval and monitoring) and a Project Management Committee (project delivery). A workshop of students, teachers and other stakeholders formulated a 10-point action plan, which was then translated into strategies and initiatives specific to each school by the School Project Officers (staff members released from teaching duties one day per week) and trained Student Ambassadors. Baseline surveys informed intervention development. Process data were collected on all intervention activities and these were collated and enumerated, where possible, into a set of mutually exclusive tables to demonstrate the types of strategies and the dose, frequency and reach of intervention activities.

Results
The action plan included three guiding objectives, four on nutrition, two on physical activity and one on body image. The process evaluation data showed that a mix of intervention strategies were implemented, including social marketing, one-off events, lunch time and curriculum programs, improvements in infrastructure, and healthy school food policies. The majority of the interventions were implemented in schools and focused on capacity building and healthy eating strategies as physical activity practices were seen by the teachers as already meeting students' needs.

Conclusions
While substantial health-promoting activities were conducted (especially related to healthy eating), there remain further opportunities for secondary schools to use a whole-of-school approach through the school curriculum, environment, policies and ethos to improve healthy eating, physical activity and healthy body perceptions in youth. To achieve this, significant, sustained leadership will be required within the education sector generally and within schools specifically.

Tongan adolescents' eating patterns : opportunities for intervention

The purpose of this mixed methods study was to examine the sources of food and dietary patterns of Tongan adolescents (n = 2084) and their perceptions of sociocultural influences. The study incorporated anthropometric measurements, a behavioral survey, and qualitative interviews. More adolescent Tongan females (82.5%) than males (74.3%) reported sourcing morning tea and/or lunch (females 81.9%, males 72.6%) from school canteens or nearby food outlets. More females than males reported consuming obesity-promoting foods such as packaged snack foods (females 38.2%, males 21.3%), chocolates (females 24.7%, males 15.0%), and soft drinks (females 55.3%, males 50.4%). Food purchased for consumption at schools was predominantly energy dense and nutrient poor. Ensuring that students have access to foods of high nutritional quality sourced from school or home, and restricting access to local food outlets that supply unhealthy products would improve the nutrition status of adolescents in Tonga. Furthermore, it is important that obesity prevention interventions are informed by culture-specific influences to optimize uptake of healthy diets.

Indigenous family violence : an attempt to understand the problems and inform appropriate and effective responses to criminal justice system intervention

Whilst high levels of concern about the prevalence of family violence within Indigenous communities have long been expressed, progress in the development of evidence-based intervention programs for known perpetrators has been slow. This review of the literature aims to provide a resource for practitioners who work in this area, and a framework from within which culturally specific violence prevention programs can be developed and delivered. It is suggested that effective responses to Indigenous family violence need to be informed by culturally informed models of violence, and that significant work is needed to develop interventions that successfully manage the risk of perpetrators of family violence committing further offences.

Evidence and implications for early intervention in bipolar disorder

Aims: To review the evidence that supports early intervention in the treatment of bipolar disorder.

Background: Bipolar disorder is a pleomorphic condition, with varying manifestations that are determined by a number of complex factors including the ‘‘stage’’ of illness. It is consequently a notoriously difficult illness to diagnose and as a corollary is associated with lengthy delays in recognition and the initiation of suitable treatment.

Methods: A literature search was conducted using MEDLINE augmented by a manual search.

Results: Emerging neuroimaging data suggests that, in contrast to schizophrenia, where at the time of a first-episode of illness there is already discernible volume loss, in bipolar disorder, gross brain structure is relatively preserved, and it is only with recurrences that there is a sequential, but marked loss of brain volume. Recent evidence suggests that both pharmacotherapy and psychotherapy are more effective if instituted early in the course of bipolar disorder, and that with multiple episodes and disease progression there is a noticeable decline in treatment response.

Conclusions: Such data supports the notion of clinical staging, and the tailored implementation of treatments according to the stage of illness. The progressive nature of bipolar disorder further supports the concept that the first episode is a period that requires energetic broad-based treatment, with the hope that this could alter the temporal trajectory of the illness. It also raises hope that prompt treatment may be neuroprotective and that this perhaps attenuates or even prevents the neurostructural and neurocognitive changes seen to emerge with chronicity. This highlights the need for early identification at a population level and the necessity of implementing treatments and services at a stage of the illness where prognosis is optimal.

Interrogating the ethics of literacy intervention in Indigenous schools

Recognising that literacy is fundamental to the educational success of Indigenous students, this essay reviews current literacy intervention programs from a social justice perspective. It reveals the tension between policies and initiatives that have addressed the two key rights of Indigenous people – the right to access mainstream knowledge and language through the provision of empowering education and the right to sustain their own languages and cultures through culturally responsive education. In particular, the essay focuses on the National Accelerated Literacy Program (NALP) – a large-scale initiative supported by the former Liberal and the current Labour government in 2004-2008. A spin-off from NALP has been the formation of the Accelerated Literacy Consultants’ Network that provides professional development sessions in Accelerated Literacy and literacy education more broadly to teachers from Aboriginal Independent Community Schools across Australia. The essay questions the view of justice in the NALP’s theoretical and pedagogical design and its effects on teaching and learning in Aboriginal schools. The paper, then, discusses the primacy of ethics in literacy education in order to make it more hospitable and responsive to cultural-linguistic differences.

Distant relations : limits to relational contracting in domestic violence programmes

Purpose – The purpose of this paper is to assess the applicability of relational contract theory in situations where government departments contract with non-government welfare organisations to deliver human service programmes. Its limits are highlighted by an assessment of programmes for domestically violent men that epitomise “management of incomplete contracts” central to the theory.

Design/methodology/approach – The paper is based on an evaluation of contracted-out programmes for perpetrators of domestic violence in Australia that set out to compare and contrast distinct models of service delivery by documenting programme logic, service delivery effectiveness and effects on programme participants. It reflects on the difficulties of monitoring such programmes and considers the implications of this for contracting theory and for human service practice.

Findings – In contrast to critiques of contracting-out in a neo-liberal environment that emphasise how accountability and reporting requirements limit the autonomy of contracted agencies, this paper highlights considerable variation in how programmes were managed and delivered despite standardised service delivery contracts developed by the government department funding the programmes. This leads to a consideration of “incomplete contracts” where service delivery outcomes are hard to measure or there is limited knowledge of the contracted agencies by the contracting government department.

Originality/value – The paper highlights a situation in which the recommendations of relational contracting theory can exacerbate the difficulties of quality assurance rather than minimise them. It then argues a need for workforce development in the government departments and the contracted agencies, to enable a nuanced monitoring of the programmes' service delivery and promotion of quality assurance processes.