Increasing community capacity to prevent childhood obesity : challenges, lessons learned and results from the Romp & Chomp intervention

Background
Obesity is a major public health issue; however, only limited evidence is available about effective ways to prevent obesity, particularly in early childhood. Romp & Chomp was a community-wide obesity prevention intervention conducted in Geelong Australia with a target group of 12,000 children aged 0-5 years. The intervention had an environmental and capacity building focus and we have recently demonstrated that the prevalence of overweight/obesity was lower in intervention children, post-intervention. Capacity building is defined as the development of knowledge, skills, commitment, structures, systems and leadership to enable effective health promotion and the aim of this study was to determine if the capacity of the Geelong community, represented by key stakeholder organisations, to support healthy eating and physical activity for young children was increased after Romp & Chomp.

Methods
A mixed methods evaluation with three data sources was utilised. 1) Document analysis comprised assessment of the documented formative and intervention activities against a capacity building framework (five domains: Partnerships, Leadership, Resource Allocation, Workforce Development, and Organisational Development); 2) Thematic analysis of key informant interviews (n = 16); and 3) the quantitative Community Capacity Index Survey.

Results
Document analysis showed that the majority of the capacity building activities addressed the Partnerships, Resource Allocation and Organisational Development domains of capacity building, with a lack of activity in the Leadership and Workforce Development domains. The thematic analysis revealed the establishment of sustainable partnerships, use of specialist advice, and integration of activities into ongoing formal training for early childhood workers. Complex issues also emerged from the key informant interviews regarding the challenges of limited funding, high staff turnover, changing governance structures, lack of high level leadership and unclear communication strategies. The Community Capacity Index provided further evidence that the project implementation network achieved a moderate level of capacity.

Conclusions
Romp & Chomp increased the capacity of organisations, settings and services in the Geelong community to support healthy eating and physical activity for young children. Despite this success there are important learnings from this mixed methods evaluation that should inform current and future community-based public health and health promotion initiatives.

Trial Registration Number: ANZCTRN12607000374460

Supporting information needs of senior citizens in community aged care

To address the challenge of an ageing population in an information society, it is important to introduce information systems to assist the aged people in maintaining and improving their quality of life. An understanding of what information aged people need, how they seek and use information, and how they adopt Information and Communication Technology (ICT) is required. This paper reports the findings of an empirical study undertaken in Australia to understand the information needs of senior citizens who reside in the community. The study aims to understand how ICT can support the independent living of senior people in the community from both the social and health perspectives. We offer a new understanding of the information needs of aged people in the community and extend the information systems research in aged care. This research also contributes to the development of innovative ICT enabled aged care service solutions in community aged care.

An audit of local government planning tools for their potential use in addressing community food and nutrition issues

Issues addressed: This project aimed to identify how local government planning tools could be used to influence physical and policy environments to support healthy eating behaviours in communities.
Methods: An audit of Queensland's legislative and non-legislative local government planning tools was conducted by a public health nutritionist to assess their potential use in addressing strategies to achieve positive nutrition outcomes. Ten strategies were identified and covered the following themes: improving access to healthy foods and drinks; increasing access to breastfeeding facilities; decreasing fast food outlet density; and unhealthy food advertising. 
Results: The audit found that all of the 10 strategies to achieve positive nutrition outcomes could be considered through three or more of the planning tools.
Conclusion: Based on the findings of this audit, local government planning tools provide opportunities to address food and nutrition issues and contribute toward creating physical and policy environments that support healthy eating behaviours.

A good lives model of clinical and community rehabilitation

Aims of the paper. The aim of this paper was to introduce the Good Lives Model, originally developed for offender rehabilitation, to the clinical rehabilitation community. We argue that this model has considerable promise, both as a ‘thinking tool’ and as an integrative framework emphasizing the centrality of the person in clinical and community rehabilitation for complex and chronic health conditions.

Key findings and implications. The essential features of a good rehabilitation theory are first outlined. These are the general principles and assumptions that underpin a theory, the aetiological assumptions and the intervention implications. The Good Lives Model for clinical rehabilitation is then described in terms of these three components of a good rehabilitation theory.

Conclusions and recommendations. The Good Lives Model has considerable promise as a tool for integrating many diverse aspects of current best practice in rehabilitation while maintaining the individual client as the central focus. At the same time it is provisional and further theoretical development and empirical support is required.

Youth as an artefact of expertise : problematizing the practice of youth studies in an age of uncertainty

At the start of the 21st century the Liberal democracies, including Australia, are characterized by profound social, economic and cultural transformations. Community, policy and academic discourse is marked by widespread adult anxieties about today’s young people. Representations of youth in the institutional domain of ‘youth studies’ can be conceived as artefacts of the activities of diverse forms of expertise. This paper will focus on the institutionalized processes of abstraction which construct these truths, and the roles played by these processes of abstraction in the restless problematization of ‘youth’ as the object of countless competing and complementary governmental programmes. There has been, in recent years, increased debate about how to do youth studies and how to represent youth. The paper will argue that any rethinking or reassessment of the modes of representing youth ought to take some account of the institutional and abstract nature of these processes of representation, and of the implication of these processes in the regulation of populations of young people; populations which are rendered knowable in all their diversity only through these processes of representation.

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

Background: 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’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.
Methods: 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.
Results: 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.
Conclusions: 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.

Observing the behaviour and interactions of adults with congenital deafblindness living in community residences

Background Adults with congenital deafblindness (CDB) have received little attention from researchers. In this study we examined the nature of interactions between adults with CDB and the staff who mediate their support, and investigated the reliability of an observation coding system, originally designed for observing adults with severe intellectual disability.

Method The behaviours of 9 adults with CDB, including their interactions with support staff from 2 community residences, were recorded and subsequently coded by 2 observers.

Results Interrater reliability, measured using Cohen's k, was variable across the coding system. Adults with CDB were predominantly observed to be disengaged, with few observations of engagement according to the coding schedule's definition of engagement. Interactions between the residents and support staff were rare.

Conclusion The introduction of interventions designed for staff to promote resident engagement in social interaction is recommended.

Towards web support for tacit knowledge exchanges

Organisations are continually looking for means to stimulate innovation and creativity, within and across working groups, functions and geographical boundaries. One of the ways to achieve this is through tacit knowledge exchanges in the form of sharing and transfer of knowledge by means of narratives, storytelling, reminders, best practices etc. Knowledge is an invaluable part of the shared practices of communities that need, create, adapt, transform, shape and use it. These Communities of Practice (CoPs) are informally created, evolve over time, and socially bind people together that share the same interests and passions. At the same time, organisations are turning more towards information technology and seek ways of leveraging their investments in Web technologies, in particular, to foster knowledge exchanges between individuals and working groups. The Web may be applied in new, innovative ways to draw dispersed community members together virtually and in particular, to promote tacit knowledge exchanges. We argue for a content-rich web environment that combines tools, services and mechanisms tailored towards tacit knowledge exchanges to support the unique work practices and situational knowledge needs of CoPs.

Reducing unhealthy weight gain in Fijian adolescents : results of the Healthy Youth Healthy Communities study

Obesity is a significant problem among adolescents in Pacific populations. This paper reports on the outcomes of a 3-year obesity prevention study, Healthy Youth Healthy Communities, which was part of the Pacific Obesity Prevention in Communities project, undertaken with Fijian adolescents. The intervention was developed with schools and comprised social marketing, nutrition and physical activity initiatives and capacity building designed to reduce unhealthy weight, and the individual exposure period was just over 2-year duration. The evaluation incorporated a quasi-experimental, longitudinal design in seven intervention secondary schools near Suva (n = 874) and a matched sample of 11 comparison secondary schools from western Viti Levu (n = 2,062). There were significant differences between groups at baseline; the intervention group was shorter, weighed less, had a higher proportion of underweight and lower proportion of overweight, and better quality of life (Pediatric Quality of Life Inventory only). At follow-up, the intervention group had lower percentage body fat (-1.17) but also a lower increase in quality of life (Assessment of Quality of Life instrument: -0.02; Pediatric Quality of Life Inventory: -1.94) than the comparison group. There were no other differences in anthropometry, and behaviours’ changes showed a mixed pattern. In conclusion, this school-based health promotion programme lowered percentage body fat but did not reduce unhealthy weight gain or influence most obesity-promoting behaviours among Fijian adolescents. Despite growing evidence supporting the efficacy of community-based approaches to reduce obesity among children of European descent, findings from this study failed to demonstrate the efficacy of a community capacity-building approach among an adolescent sample drawn from a different sociocultural, economic and geographical context. Additional ‘top–down’ or other innovative approaches may be needed to reduce adolescent obesity in the Pacific.

Evaluation of the Living 4 Life project : a youth-led, school-based obesity prevention study

The Living 4 Life study was a youth-led, school-based intervention to reduce obesity in New Zealand. The study design was quasi-experimental, with comparisons made by two cross-sectional samples within schools. Student data were collected at baseline (n = 1634) and at the end of the 3-year intervention (n = 1612). A random-effects mixed model was used to test for changes in primary outcomes (e.g. anthropometry and obesity-related behaviours) between intervention and comparison schools. There were no significant differences in changes in anthropometry or behaviours between intervention and comparison schools. The prevalence of obesity in intervention schools was 32% at baseline and 35% at follow-up and in comparison schools was 29% and 30%, respectively. Within school improvements in obesity-related behaviours were observed in three intervention schools and one comparison school. One intervention school observed several negative changes in student behaviours. In conclusion, there were no significant improvements to anthropometry; this may reflect the intervention’s lack of intensity, insufficient duration, or that by adolescence changes in anthropometry and related behaviours are difficult to achieve. School-based obesity prevention interventions that actively involve young people in the design of interventions may result in improvements in student behaviours, but require active support from leaders within their schools.

Back to basics : empirical support for the importance of release planning in reducing sex offender recidivism

This article reports findings from a series of empirical studies investigating whether poor release planning might contribute to sex offender recidivism. A coding protocol was developed to measure the comprehensiveness of release planning which included items relating to accommodation, employment, pro-social support, community based treatment, and the Good Lives Model (T. Ward & C.A. Stewart, 2003) secondary goods. The protocol was retrospectively applied to groups of recidivist and non recidivist child molesters, matched on static risk level and time since release. As predicted, overall release planning was significantly poorer for recidivists compared to non recidivists. The accommodation, employment, and social support items combined to best predict recidivism, with predictive accuracy comparable to that obtained using static risk models. Results highlighted the importance of release planning in efforts to reduce sex offender recidivism. Implications for policy makers and community members are briefly discussed.

Assessment of community reintegration planning for sex offenders

Poor planning for reintegrating child molesters from prison to the community is a likely risk factor for sexual recidivism. The quality of reintegration planning was retrospectively measured for groups of recidivist (n = 30) and nonrecidivist (n = 30) child molesters who were individually matched on static risk level and time since release. Recidivists had significantly poorer reintegration planning scores than nonrecidivists, consistent with a previous study by the authors. Data from both studies were combined (total N = 141), and survival analyses showed that poor reintegration planning predicted an increased rate of recidivism. Accommodation, employment, and social support planning combined to predict recidivism, with predictive validity comparable to static risk models (area under the curve = .71). Summing these items yielded a scale of reintegration planning quality that differentiated well between recidivists and nonrecidivists and may have practical utility for risk assessment as an adjunct to static models.

Information needs in community aged care

This paper focuses on the information needs and behaviours of senior citizens and their carers in the community. Two case studies concerning elderly stroke patients and their carers are described and discussed. Analysis of the case study data reveals a number of themes including the actual information needs and information behaviours of the senior citizens, the importance of proxy information seekers and advocates and the need for usable, accessible and useful tool to support the needs of care recipients. A preliminary framework is developed that highlights important aspects of supporting the information needs of care recipients and carers in community aged care. Finally we suggest opportunities for technology interventions that address various information needs of senior citizens in the community.

Ways in which 'community' benefits frail older women's well-being : '... we are much happier when we feel we belong'

Aim: This paper aims to explore frail older women’s lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well-being.

Method: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews.

Results: This research obtained a rich and detailed account of the aspects of ‘community’ identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation.

Conclusion: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.