Process evaluation of a community-based adolescent obesity prevention project in Tonga

Abstract

BackgroundThe 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.MethodsMYP 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.ResultsWhile 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.ConclusionsThe 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.

Pilot project of the Nutrition-Friendly School Initiative (NFSI) in Ouagadougou, Burkina Faso and Cotonou, Benin, in West Africa

“…In developed countries, irrespective of NFSI, the prevention of obesity in children and adolescents is a priority focus of school health programs, but results in this regard have been mitigated (17). It was suggested that multi-component interventions (promoting healthy eating, less sedentary behavior and more physical activity), particularly when they target whole communities and environments rather than merely schoolchildren and education, may be more effective in developed countries (17), as well as in developing countries such as in the Pacific (18). In a metropolitan area in North India, a case-control study among school adolescents shows for the first time that a low-cost nutrition and lifestyle educational intervention was effective in improving participants' diet, reducing abdominal adiposity and reducing fasting blood glucose levels, after only a few months (19).…”

Eating for the better: a social marketing review (2000–2012)

“…Ma'alahi Youth Project Fotu et al (26,43,68,69) Healthy breakfast, school lunches, F&V intake, water…”

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“…However, limited large scale studies are beginning to share evaluation tools on websites for public use and descriptions of process evaluation objectives and associated data collections tools employed are increasingly being published in peer reviewed journals. This has occurred in interventions in mental health [45], weight management [16] and physical activity [46]. There are additionally some evaluation guides available online (grey literature) that incorporate evaluation templates as well as sample questions for semi-structured interviews and focus groups [47,48].…”

“…Common elements assessed in a process evaluation include program reach, fidelity in relation to program protocol, program context, quality and dose delivered and received by participants [14,15]. A community based obesity prevention study in adolescents living in Tonga completed a process evaluation by research staff recording all intervention-related activities, the frequency of the activity, the reach of that activity (how many people were involved in the program) and the resources required [16]. The purpose of a formative evaluation is to improve the quality of performance or the delivery of the program prior to rollout and is conducted either before or during the program [17].…”