BackgroundIn Australia, around 67% of adults and 25% of children (5–17 years) are currently overweight or obese (Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017–18, 2018). The Campbelltown – Changing our Future study will translate ‘a whole of system’ approach, previously trialed in rural communities in Victoria and the Australian Capital Territoty, to Campbelltown Local Government Area (LGA), a socioeconomically and ethnically diverse urban community in south western Sydney, NSW.MethodsThe study intervention will use a five-step approach; 1 – set up a childhood obesity monitoring system by collecting baseline data from children in primary schools across Campbelltown LGA to give a local context to the community when developing the systems map; 2 - key stakeholders develop systems maps which inform the development of the interventions; 3 - key stakeholders and community groups identify priority areas for action and form working groups; 4 - implementation of the interventions; 5 - evaluation of the interventions. The study will adopt a longitudinal pre/post design with repeated measures at baseline, 2 years and 4 years. Both qualitative and quantitative methods will be used to collect and analyse the data.DiscussionAddressing childhood overweight and obesity is complex and requires a multifaceted intervention. This approach has the capacity to impact a range of factors that influence childhood overweight and obesity utilising existing capacity of multiple partners with broad community reach. Findings will develop local responses which capture the complexity of obesity at a community level and further our understanding of the interrelationships and relative importance of local factors impacting childhood overweight and obesity. This study aims to provide evidence for systems methods and approaches suitable for adaption and scaling and may provide evidence of successful community intervention elements.
Background Obesity is a chronic disease that contributes to additional comorbidities including diabetes, kidney disease and several cancers. Change4Campbelltown implemented a ‘whole of system’ approach to address childhood overweight and obesity. We present methods to track implementation and stakeholder engagement in Change4Campbelltown. Methods Change4Campbelltown aimed to build capacity among key leaders and the broader community to apply techniques from systems thinking to develop community-led actions that address childhood obesity. Change4Campbelltown comprised development of a stakeholder-informed Causal Loop Diagram (CLD) and locally-tailored action plan, formation of key stakeholder and community working groups to prioritise and implement actions, and continuous monitoring of intervention actions. Implementation data included an action register, stakeholder engagement database and key engagement activities and were collected quarterly by the project management team over 2 years of reporting. Results Engagement activities increased level of community engagement amongst key leaders, the school-sector and community members. Community-led action increased as engagement increased and this action is mapped directly to the primary point of influence on the CLD. As action spread diversified across the CLD, the geographical spread of action within the community increased. Conclusions This paper provides a pragmatic example of the methods used to track implementation of complex interventions that are addressing childhood overweight and obesity.
Background In 2015 two billion people were estimated to be above a healthy weight globally, contributing to a rapid increase of non-communicable diseases. Evidence indicates multi-faceted and community-led interventions are most effective in addressing the complexity of childhood overweight and obesity. Campbelltown - Changing our Future is a practical example of an urban, community-based whole of system approach to identify, develop and implement community-led interventions to address this issue. Methods Key community stakeholders and leaders, who had power to change environments and norms, were engaged in a series of three workshops to develop a systems map. A Group Model Building (GMB) framework was used across the workshops to facilitate community perception of the key factors that compose the system that influences childhood overweight and obesity within an urban community. Community members were asked to identify and commit to community-led actions to effect change on various elements of the system. Results Over 200 community members were engaged in the GMB process, establishing the following systems map themes: physical activity and sedentary behaviour, healthy eating, knowledge and education and social factors. A further 200 community members are contributing to 90 ongoing community-led comprehensive interventions to address childhood overweight and obesity. Conclusions Over 90 actions are active within the community, ranging from high profile athletes’ role modelling reading to children through to a Council healthy food and drink policy. These actions contribute to creating change across multiple levels of the system, an effective, sustainable solution to addressing childhood overweight and obesity. Key messages Practical implementation of a whole of system approach in an urban community produces community-led action. A whole of systems approach facilitates community engagement to address complex issues.
Introduction The recent Lancet Commissions report on The Global Syndemic of Obesity, Undernutrition, and Climate Change highlights the need for comprehensive actions to address the global epidemic of obesity. The Campbelltown - Changing our Future project utilised a community led participatory systems mapping approach to develop interventions to address childhood obesity in an urban environment. While there is evidence demonstrating the impact of systems approaches on outcomes, there is limited examples internationally demonstrating what works in which circumstances, for whom and most importantly how. Methods A realist evaluation framework was used by project staff to identify key mechanisms that enabled project outcomes. This framework uses four key interrelated concepts: “mechanism”, “context”, “outcome pattern” and “context-mechanism-outcome (CMO) pattern configuration”. Five key underlying properties that influenced the project were analysed using the CMO pattern configuration. Results The five key properties that the project team has identified as key influences in the translation of a whole of system approach in an urban community are: endorsement, ways of working, deliberative learning, personality traits and partnerships. These mechanisms enabled over 90 community-led actions to be established. Conclusions The five properties work harmoniously together when performed in an enabling context to produce comprehensive, community-led action. Understanding “how” these theories interact and the optimal context provides opportunity for a broader understanding on the process of practical implementation of a whole of system approach. Key messages Provides insight into how a practical example of a whole of system approach is implemented. Endorsement, flexible ways of working, deliberative learning, personality traits and partnerships are enablers of systems based participatory approaches addressing obesity within a community setting.
Issue addressedThere is growing evidence that online parent‐focused child healthy lifestyle interventions can improve healthy eating practices and food environments in the home. Greater understanding of whether and how parents engage with these online interventions is needed. This study evaluated the reach, acceptability and impacts of an online parent healthy lifestyle intervention.MethodsA pilot study was conducted in New South Wales during the COVID‐19 pandemic when stay‐at‐home public health orders were in place (July–August 2021). A concurrent mixed methods design was adopted. Data collection measures were: an online participant survey at baseline, post‐intervention and 3‐month follow‐up; two online post‐intervention focus groups; and web metrics at post‐intervention and 3‐month follow‐up.ResultsThere were 181 intervention participants, primarily mothers with high education levels and living in advantaged areas: 43 (24%) completed surveys post‐intervention; and of these, 35 (81%; 19% of participants) completed surveys at follow‐up. Sixteen mothers participated in focus groups. Parents' knowledge, self efficacy, role modelling and behaviours improved, but there were no significant differences detected over time. Metrics and survey data indicated webinar recordings, particularly the topics of ‘Fussy Eating’ and ‘Screen time and sleep’, had the greatest engagement and most perceived them as useful (93% and 96%, respectively).ConclusionsAn online healthy lifestyle intervention to support parents in providing opportunities for their children to engage in healthier lifestyle behaviours was appealing and acceptable to mothers and has the potential to improve families' healthy lifestyle behaviours. Enhancing intervention reach amongst fathers and priority populations, as well as incorporating design elements to enhance engagement will be important.So what?An online healthy lifestyle intervention reached and engaged parents, despite being faced with additional parenting challenges arising from COVID‐19 stay‐at‐home orders.
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