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.

Applying socio-cultural lenses to childhood obesity prevention among African migrants to high-income western countries : the role of acculturation, parenting and family functioning

Migration from third-world and low-income countries to high-income Western countries presents significant challenges for individuals and families, and for health service providers in the receiving societies. Cultural conflicts related to preferred body size/shape and parenting practices, together with differential inter generational rates and styles of acculturation, can affect nutritional and lifestyle choices and be associated with high rates of childhood obesity. Using African cultures as an example, this paper examines these issues. It concludes that, in designing and implementating obesity prevention programmes, health service providers need to understand these factors and how they play out.

Should early childhood be a priority period for obesity prevention?

This thesis explored a range of issues relating to overweight and obesity in children aged 0 to 5 years in Victoria, Australia. Key findings included relatively low prevalence and decreasing trends of overweight and obesity, and strong existing support for health behaviours in kindergartens and child care services.

Community capacity building for obesity prevention

The study aimed to understand how capacity-building was operationalised within obesity prevention projects. It clarified definitions of capacity building and identified patterns in the process of building capacity. A potential framework to guide communities to formalise and contextualise capacity building, and prioritise action for leveraging existing capacities was proposed.

Healthy eating and obesity prevention for preschoolers : a randomised controlled trial

Background
Developing effective prevention and intervention programs for the formative preschool years is seen as an essential step in combating the obesity epidemic across the lifespan. The overall goal of the current project is to measure the effectiveness of a healthy eating and childhood obesity prevention intervention, the MEND (Mind Exercise Nutrition Do It!) program that is delivered to parents of children aged 2-4 years.

Methods/Design
This randomised controlled trial will be conducted with 200 parents and their 2-4 year old children who attend the MEND 2-4 program in metropolitan and regional Victoria. Parent-child dyads will attend ten 90-minute group workshops. These workshops focus on general nutrition, as well as physical activity and behaviours. They are typically held at community or maternal and child health centres and run by a MEND 2-4 trained program leader. Child eating habits, physical activity levels and parental behaviours and cognitions pertaining to nutrition and physical activity will be assessed at baseline, the end of the intervention, and at 6 and 12 months post the intervention. Informed consent will be obtained from all parents, who will then be randomly allocated to the intervention or wait-list control group.

Discussion
Our study is the first RCT of a healthy eating and childhood obesity prevention intervention targeted specifically to Australian parents and their preschool children aged 2-4 years. It responds to the call by experts in the area of childhood obesity and child health that prevention of overweight in the formative preschool years should focus on parents, given that parental beliefs, attitudes, perceptions and behaviours appear to impact significantly on the development of early overweight. This is 'solution-oriented' rather than 'problem-oriented' research, with its focus being on prevention rather than intervention. If this is a positive trial, the MEND2-4 program can be implemented as a national program.

Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN12610000200088

The politics of 'sustainability': a critical discourse analysis of Victorian Government policy discourse, 1999-2006

Since its emergence during the 1980s the idea of sustainability has come to provide the dominant frame within which environmental policy is debated. Thus, for many ‘sustainability’ represents the best way to address the economic, social and environmental effects of the myriad of environmental issues facing human societies, including biodiversity loss, soil erosion, pollution of waterways, ozone depletion and climate change. There are however, widely divergent views advocated as to what sustainability means, which has important implications for how serious environmental issues are understood to be, why they are important, what has caused them, and what needs to be done to address them. Given the diversity of such views, the consequences for policy making, and the likelihood of effective responses being developed, are self evident. Within this context, this thesis investigates the politics of sustainability, focussing particularly on the way in which it is defined, because of the implications this has for the way in which environmental issues are understood and addressed. Following a review of various approaches to analysing environmental policy (traditional, mainstream, ecopolitical and discursive), Norman Fairclough’s approach to discourse analysis (Critical Discourse Analysis) was identified as having particular merit. Fairclough’s approach avoids the assumption that policy issues exist independently of the way they are framed and offers a perspective on discourse that links the social theoretical concerns of Foucault with the micro level concerns of linguistics. It also provides a means for taking environmental policy analysis in directions that that have attracted relatively limited attraction, namely the detailed analysis of the ideological effects of language on environmental policy. In this thesis Fairclough’s approach is used to explore how three storylines of sustainability (sustainable development, environmentally sustainable growth and transforming society) and their associated discourses shaped environmental policy making in Victoria, Australia, between 1999 and 2006. In undertaking this analysis, I examined the political and institutional context informing policy making (social practice); the contested process of text production (discourse practice), and; the detailed wording of a policy text (textual analysis). A major policy statement on environmental sustainability released by the Victorian Government in 2005 is subjected to detailed analysis. Based on the analysis undertaken, the substantive finding from this research is that rather than moving beyond neoliberalism, the Victorian Government embraced an approach to sustainability that was informed by neoliberalism and (weak) ecological modernisation, which constructs sustainability in ways that limit its importance and constrain the types of responses that could be advocated. In doing so, it drew heavily on notions of natural assets and ecosystems services as ways to make sense of the environment and why it is important. The Victorian Government also highlighted that environmental issues are caused by the cumulative effects of individual choices, and emphasized the importance of individual choice and behavioural change as central features of sustainability, while restricting opportunities for more transformative ideas to be heard. The broader conclusion arising from this research is that approaches to environmental policy that rely on neoliberal and (weak) ecological modern discourses are flawed, because, in commodifying nature, limiting the nature and magnitude of change required, and placing responsibility onto individuals they offer a constrained understanding of the challenge of sustainability and what needs to be done about it. The overall contribution made by this research is an improved understanding of the discursive nature of the politics of sustainability and the influence of neoliberalism and ecological modernisation, the use of a methodology that has attracted relatively limited attention within environmental policy (despite its widespread use in other areas of policy) and the documentation of a period of significant environmental policy reform in Victoria.

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.

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

Best practice in obesity prevention has generally been defined in terms of ‘what’ needs to be done while neglecting ‘how’. 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.

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

Child obesity research has generally not examined multiple layers of parent–child relationships during weight-related activities such as feeding, eating and play. A literature review was conducted to locate empirical studies that measured parent– 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–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–child relationship.

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’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 2–6 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.