Social support is a key component in managing long-term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre-post-test methodology was employed. A social network tool was completed by 45 (87%) participants either pre- or post-intervention, of which 24 (46%) participants completed the tool pre- and post-intervention. In addition, 14 semi-structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre- and post-intervention namely, health professionals, close family and partners. However, post-intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre-intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self-management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.

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Background Limited resources make prevention of complex population-level issues such as obesity increasingly challenging. Collaboration and partnerships between organisations operating in the same system can assist, however, there is a paucity of research into how relationships function at a local level. The aim of this study was to audit initiatives, explore networks, and identify potential opportunities for improving the obesity prevention system in a Health Service area of Western Australia (WA). Methods A mixed-methods study was undertaken in a metropolitan Health Service in Perth, WA in 2019–20. Structured face-to-face interviews (n = 51) were conducted with organisations engaged in obesity prevention, to identify prevention initiatives and their characteristics using a Systems Inventory tool. The Research Team identified the 30 most active organisations during the Systems Inventory, and an online Organisational Network Survey was administered to explore: relationships across six domains; partnership duration; frequency of interaction with other organisations; barriers to implementation; and key contributions to obesity prevention. Descriptive statistics were used to summarise barriers, contributions and Systems Inventory data. Organisational Network Survey data were analysed using social network analysis through UCINET 6 for Windows and Netdraw software. Whole network and cohesion scores were calculated: average degree; density; diameter; and degree centralization. Core-periphery analysis was conducted to identify densely connected core and sparsely connected periphery organisations. Results The Systems Inventory identified 189 unique prevention initiatives, mostly focusing on individual-level behaviour change. Fifty four percent (n = 15) of the Organisational Network Survey respondent organisations and most core organisations (67%, n = 8) were government. The information and knowledge sharing network had a density of 45% indicating a high level of information and knowledge exchange between organisations. The lowest densities were found within the receiving (3.3%), providing (5.5%) and sharing (5.6%) funding networks, suggesting that these formal relationships were the least established. Conclusion Applying a systems thinking lens to local obesity prevention revealed that initiatives conducted focused on individual-level behaviour change and that collaboration and communication between organisations focused on information sharing. Capturing the extent and nature of initiatives and the way partnerships operate to improve obesity prevention can help to identify opportunities to strengthen the networks.

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IntroductionLittle progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related to obesity on a global scale. Systems thinking is emerging as a suitable approach for obesity prevention, as it allows health researchers, practitioners and policy-makers to systematically synthesise existing data, expose gaps, inform priority setting and identify leverage points in the system. The aim of this study is to trial a systems thinking approach to better understand the local obesity prevention system, and identify gaps and viable opportunities for health promotion activities to strengthen obesity prevention efforts in an Australian metropolitan health service.Methods and analysisA mixed methods design will be undertaken in a metropolitan health service area in Perth, Western Australia in 2019–2020. A systems inventory audit will be used to identify physical activity, nutrition and overweight/obesity prevention activities taking place in the study area. An organisational network survey will be administered, and a social network analysis undertaken to examine relationships between organisations in the network. The relationships and interactions will compare the level and type of interactions each organisation has within the network. Parameters including density, centrality and betweenness will be computed using UCINET and Netdraw.Ethics and disseminationEthics approval has been obtained from the Curtin University Human Research Ethics Committee (approval number HRE2017-0862). Results will be reviewed with members of the advisory group, submitted to relevant journals and presented at relevant conferences to health promotion practitioners and policy-makers. The area health service, as co-producers of the research, will use findings to inform policy and strategy across the study area.

This study aimed to use systems thinking tools to understand network relationships to inform discussions, policy, and practice to improve nutrition, physical activity, and overweight/obesity prevention activities in a Western Australian local government area. An audit of nutrition, physical activity, and obesity prevention activities was conducted, and identified organizations were invited to participate in an organizational network survey. Social network analysis (SNA) determined the extent to which organizations shared information, knowledge, and resources; engaged in joint program planning; applied for and shared funding; and identified operational barriers and contributors. SNA data were mapped and analyzed using UCINET 6 and Netdraw software. Five organizations within the network were identified as core; the remainder were periphery. The strongest networks were sharing information, and the weakest was funding. The connections were centralized to one organization, enabling them to readily influence other organizations and network operations. Remaining organizations indicated limited partnership across the networks. Strengthened collaborations and partnerships are essential to health promotion, as they extend reach and organizational capabilities. This study provides a process for undertaking network analysis, identifying leverage points to facilitate communication and information sharing, and reorienting of collaborations and partnerships to consolidate scarce resources and act strategically within a bounded area. There is a need for stronger relationships between organizations and a reorientation of partnerships to facilitate resource sharing within the local government area, to improve nutrition, physical activity, and obesity prevention practices. SNA can assist in understanding organizational prevention networks within a bounded area to support future planning of practices and policy.

While the household in which a child grows up is considered a critical environment that influences nutrition outcomes, there is little research examining the influence of household composition and structure on complementary feeding practices. This study examined the influence of household structure and composition on complementary feeding practices, using the Ethiopian Demographic and Health Survey (EDHS), 2000 to 2016. The composition variables were calculated from the attributes of household members (alters) and the structure variables from their kinship status. A multilevel mixed-effects regression model, specifying survey rounds as the random effect, was used to examine the association between household structure/composition and the Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD). The average Marginal Effects (MEs) were calculated to facilitate practical interpretation. Children of caregivers with a higher number of alters (degree), unique number of kinship category (effect size), closely related (constraint), and mixed-age alters (age diversity) seemed to increase the probability of meeting the MDD. Degree and effective size decreased the probability of meeting MMF, while constraint increased it. Overall, this study revealed some associations between household structure and composition and complementary feeding practices. Hence, complementary feeding interventions could be adapted to account for the household structure and composition variations.