Applying a performance monitoring framework to increase reach and adoption of children’s healthy eating and physical activity programs

Abstract

The allocation of a significant amount of new funding for health promotion in Australia through the National Partnership Agreement on Preventive Health (2009-14) created a unique opportunity to implement a comprehensive approach to the prevention of chronic diseases and demonstrate significant health improvements. Building on existing health promotion infrastructure in Local Health Districts, the NSW Ministry of Health adopted a scaled-up state-wide capacity-building model, designed to alter policies and practices in key children's settings to increase healthy eating and physical activity among children. NSW also introduced a performance monitoring framework to track implementation and impacts. This paper describes the model that NSW developed for monitoring state-wide programs in the Children's Healthy Eating and Physical Activity Program and presents the model's application to early childhood education and care and primary school settings, including current results. This approach to monitoring the scaling up of program implementation at the state-wide level has potential for more widespread application in other policy areas in NSW.

Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving

“…18–22, 24–30, 32, 34, 35 Two of the three practice-based evidence cases were from LMICs. 31, 33 Fourteen of the cases described an intervention that fit into one of the seven categories of investment in physical activity (Figure 1), with the most frequently represented categories being those of community-wide programs (n=6), 20, 22, 24, 31, 32, 34 ‘whole of school’ programs (n=3), 23, 26–28, 30 and physical activity promotion or NCD prevention integrated into the health care system (n=3). 18, 25, 29 No cases relating to the categories of transport systems prioritising active travel, or urban design policies and infrastructure, were identified.…”

“…The remaining cases involved health education delivered by telephone or text message. 19, 21 Six cases described interventions targeting children or youth, 18, 23, 25–28, 30, 33 while four focused on adults, 19, 24, 29, 35 one on older adults, 32 and another one on both adults and older adults. 34 Two cases related to all age groups 21, 22 and two were not specific about age groups.…”

“…Scalability was most commonly defined exclusively as extending the reach of an intervention by replicating it in other localities, cities or states (horizontal scale-up) 16 (n=6), 20, 24, 25, 30, 34, 35 as institutionalising the intervention at government level so it could reach all citizens within a given jurisdiction (vertical scale-up) 16 (n=5), 22, 23, 29, 31, 32 or as a combination of horizontal and vertical scale-up (n=4). 18, 19, 21, 26–28 Most of the monitoring and evaluation activities pertaining to scalability assessed whether the program was reaching the specified target population and whether the intervention was being properly implemented, with several cases reporting deficiencies in these regards.…”

What happens once a program has been implemented? A call for research investigating strategies to enhance public health program sustainability

“…Such research has typically been non‐experimental and focused on characteristics of the program (or intervention), organisational capacity, or broader contextual factors as correlates of sustained implementation fidelity 2 . Research suggests that establishment of systems, processes and structures within organisations adopting new health programs, and building of organisational readiness and capacity that occur as part of initial implementation efforts may facilitate sustained program implementation 7 . While this research has provided important formative work for the field, to maximise the benefits of investments in population‐wide program implementation, policy makers and practitioners are primarily interested in whether planned investments are sufficient to maintain long‐term program implementation or whether ongoing investment is required to achieve this outcome.…”

“…While public health history is littered with examples of effective public health programs that were discontinued when external funds to support implementation have ceased or following attempts to transfer responsibility for ongoing program delivery, 6 a number of case studies in Australia and elsewhere have demonstrated that sustained implementation of public health programs is possible 6,7,12 . Developing an understanding of the success factors for such cases is important.…”