Selection of study designs and outcome measures compatible with community infrastructure, accompanied by process evaluation, may facilitate successful outcome evaluation.

Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has developed Live 5-2-1-0, a multi-sectoral, multi-component community-based childhood obesity prevention initiative grounded in systems thinking and participatory research principles. Building on previous work, this study continued implementation of an innovative knowledge exchange model, RE-FRAME, in two ‘new’ and two ‘existing’ Live 5-2-1-0 communities. This mixed-methods study examined follow-up data to determine the nature and extent of the model’s ability to build and sustain community capacity and facilitate the scale-up and sustainability of systems- and community-level change. Qualitative and quantitative data were collected using stakeholder interviews, and quantitative process tracking (PTT) and capacity building tools (CCBT), and were analyzed using thematic analysis and descriptive statistics, respectively. Results from three communities with baseline and follow-up CCBT data showed capacity domain scores increased (15/27; 56%) or remained constant (10/27; 37%) over the study period. PTT data showed over 50 multi-sectoral community partnerships formed in Community D (new) and 108 actions implemented. Stakeholder interviews identified having a common cause, co-ownership, champion networks and consistency of the Live 5-2-1-0 message as essential to sustainability of the initiative. RE-FRAME supports knowledge exchange and community capacity-building that is integral to initiating and sustaining a community-based childhood obesity prevention initiative.

OBJECTIVES:We describe the processes used in SCOPE, a community-based participatory research (CBPR) initiative, to achieve multisectoral engagement and collective action to prevent childhood obesity.

Childhood obesity is complex and requires a ‘systems approach’ that collectively engages across multiple community settings. Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has implemented Live 5-2-1-0—a multi-sector, multi-component childhood obesity prevention initiative informed by systems thinking and participatory research via an innovative knowledge translation (KT) model (RE-FRAME). This paper describes the protocol for implementing and evaluating RE-FRAME in two ‘existing’ (>2 years of implementation) and two ‘new’ Live 5-2-1-0 communities to understand how to facilitate and sustain systems/community-level change. In this mixed-methods study, RE-FRAME was implemented via online resources, webinars, a backbone organization (SCOPE) coordinating the initiative, and a linking system supporting KT. Qualitative and quantitative data were collected using surveys and stakeholder interviews, analyzed using thematic analysis and descriptive statistics, respectively. Existing communities described the consistency of Live 5-2-1-0 and extensive local partnerships/champions as catalysts for synergistic community-wide action; new communities felt that the simplicity of the message combined with the transfer of experiential learning would inform their own strategies and policies/programs to broadly disseminate Live 5-2-1-0. RE-FRAME effectively guided the refinement of the initiative and provided a framework upon which evaluation results described how to implement a community-based systems approach to childhood obesity prevention.

The objective of this study was to determine the impact of two nudge interventions on customers’ produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p < 0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p < 0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada.

The objective of this study was to determine the impact of two nudge interventions on customers’ produce purchases at a rural Canadian grocery store. A pre- and post-intervention observational study design was used. Sales data were gathered before and after the staggered implementation of two nudge-based interventions to encourage produce purchases: grocery cart dividers to encourage shoppers to fill one-third of their cart with produce and grocery cart plaques with information about how many fruits and vegetables were typically purchased in the store. The proportion of total sales accounted for by produce was compared between baseline and implementation of the first intervention (Phase 1), between implementation of the first intervention and the addition of the second intervention (Phase 2), and between baseline and post-implementation of both interventions together. There was a 5% relative increase (0.5% absolute increase) in produce spending between baseline and post-implementation of both interventions (10.3% to 10.8%, p<0.001, 95% CI 0.2%, 0.7%). Intervention phase-specific produce spending showed no significant change in the percentage of produce spending from baseline to Phase 1 of the intervention, and an 8% relative increase (0.8% absolute increase) in the percentage of produce spending from Phase 1 to Phase 2 of the intervention (10.3% to 11.1%, p<0.001, 95% CI 0.5, 1.1%). Simple, low-cost nudge interventions were effective at increasing the proportion of total grocery spend on produce. This study also demonstrated that partnerships with local businesses can promote healthier food choices in rural communities in Canada.