Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity - the behavior change ball

Abstract

BackgroundChildhood obesity is a ‘wicked’ public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers.DiscussionWe propose the ‘Behavior Change Ball’ as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the ‘Behavior Change Wheel’ by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system’s resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity.SummarySince integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by incorporating multiple theoretical perspectives, specifying a set of organizational behaviors and linking the analysis of these behaviors to interventions and policies. We would encourage examination by others of our framework as a tool to explain and guide the development of integrated policies for the prevention of wicked public health problems.

Addressing Childhood Obesity with Education

“…Over the past three decades childhood obesity has doubled worldwide meaning that about 170 million children less than 18 years of age are obese or overweight [14]. Researchers have associated childhood obesity with poorer health as they approach adulthood.…”

Local government officials׳ views on intersectoral collaboration within their organization – A qualitative exploration

“…For example, the ability of officials to assess the impact of their own work on PH, their beliefs about their capability to persuade stakeholders to invest in health policies, or the charisma of actors to direct the consensus-building process towards a direction that suits their interests [24,[26][27][28][29].…”

“…Also broader social forces like capitalism or globalization may indirectly shape the policy process. Further, timing, policy free space and fiscal resources are important physical opportunity factors, because decisionmaking moments are often structured, national devolved obligations need to be met and budgets limit how flexible officials can be in choosing their actions [24,[26][27][28][29].…”

“…Automatic motivation can involve work routines like wanting to involve certain colleagues because of personal connection and trust [16]. Reflective motivation can involve choices that are made based on evaluations of past policies, or carefully prepared efforts to push certain policy ideas into formal policies by officials awaiting for a 'window of opportunity' [24,[26][27][28][29][30].…”

“…For example, in an organization one may wish to characterize an aggregate measure of motivation to engage in a particular organizational behavior in terms of the mean level or the proportion who report a given level of motivation (similarly, with capability) at a certain stage in the development of integrated public health policies [17,[26][27][28][29].…”