Abstract
BackgroundPublic health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years.MethodsActivity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94).Results215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP→ IND) and indirect intervention strategies (i.e., HP→ INT→ IND, HP→ POL → IND) were used most often; networking strategies, which link at least two targets (i.e., HP→[ORG-ORG]→IND), were used the least. The program did not become more ecological over time.ConclusionsThe quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability.
Highlights
Public health promotes an ecological approach to chronic disease prevention, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs
To improve health of Australians the new public health calls for action on the ecological determinants of health [1]
Community members and service providers residing in this remote Aboriginal community, in addition to the external partnering research institution, implemented 215 activities across three intervention years
Summary
Public health promotes an ecological approach to chronic disease prevention, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. To improve health of Australians the new public health calls for action on the ecological determinants of health [1] Following these calls, public health practitioners have been encouraged to apply an ecological approach to promote active living [2] and to prevent obesity and the development of related chronic diseases such as type 2 diabetes and cardiovascular disease [3]. Person-focused strategies engage the priority population in activities that modify their knowledge, attitudes or skills related to one or more behavioural risk factors like, for example, teachers providing students with information on healthful foods. The ecological complexity of such intervention programs varies according to the settings from which participants are recruited and the combination of individual, interpersonal, community, organisational and policy targets included in the intervention strategies
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