A settings‐based theoretical framework for obesity prevention community interventions and research

Abstract

Childhood obesity presents one of the greatest challenges to the public health community because the drivers of obesity can be located at the level of individual, community, social and justice systems. The depth of complexity often gives rise to opportunities for trivial, competing, opaque, ‘homeopathic’ and indeed, potentially harmful and ineffective solutions. One of the unresolved issues in the polarity of these debates is the level at which prevention efforts should be targeted. Articulation of the most appropriate theoretical frameworks to guide prevention efforts is urgently called for. It is often argued that theoretical frameworks can provide an important structure for researching and understanding a public health problem or intervention. Well-developed theories can be used in problem-driven research to provide a conceptual framework for a study. They can contribute to an understanding and interpretation of the problem or issue being studied and can inform the selection of models or frameworks to guide action. Theoretical frameworks are, however, often under-utilised and implicit rather than clearly articulated, and rarely evaluated for their value and appropriateness. We argue that selecting, using, articulating and testing the choice of theoretical framework is an important component of rigorous population health intervention research; and aim to illustrate this point from the perspective of experience in developing, implementing and evaluating more than 14 system and community-based intervention studies in the field of childhood obesity prevention. The role of theory in research and intervention design There is no single, correct or universal theoretical framework for a particular area of study. In a complex endeavour such as obesity prevention, it is likely that several theoretical frameworks will need to be used to guide the interventions and the understanding of the results. The more important consideration is that the choice of theory or theories is driven by the research question or problem. In intervention or program-oriented research, there will be several theories that could make up a framework, so researchers have some flexibility in selecting the ‘best fit’ with the context and the outcomes sought. Careful consideration of alternative frameworks strengthens intervention thinking and design by highlighting the areas of consensus (i.e. where program design would be similar under any theoretical framework) and the areas of disagreement. The rigour of this approach enables and strengthens opportunities for reflective analysis of the attribution of measured success or failure to the success or failure of intervention and/or of theory.