Obesity Prevention And Lifestyle Research Articles

Rethinking sustainability in childhood obesity prevention interventions: learning from South Australia's Obesity Prevention and Lifestyle (OPAL) Programme.

Increases in childhood obesity have occurred across a relatively short time-period, yet childhood obesity prevention is a longer-term game. Programmes have only identified population-level changes after 12 years of on-the-ground activity [Romon et al.]. Community stakeholders can impact the success of public health interventions [Ganter et al.; Lee et al.] and they have been identified as a critical success factor for programme sustainability [Schell et al.]. Qualitative research with stakeholders (n = 59) provides their insights and understandings of the sustainability of OPAL, a South Australian childhood obesity prevention programme. Stakeholders identified activities that they thought contributed to improved sustainability of action such as embedding obesity prevention into organizational policy and plans; and installation of infrastructure within communities to modify physical environments. In contrast, there was little appetite for sustaining OPAL or other formulations of a childhood obesity prevention programme. This research has implications for planning and implementation of community-based childhood obesity prevention initiatives when considering the balance of the portfolio of activities for implementation.

Changes in weight status, quality of life and behaviours of South Australian primary school children: results from the Obesity Prevention and Lifestyle (OPAL) community intervention program

BackgroundChildhood obesity is a serious public health concern worldwide. Community-based obesity prevention interventions offer promise due to their focus on the broader social, cultural and environmental contexts rather than individual behaviour change and their potential for sustainability and scalability. This paper aims to determine the effectiveness of a South Australian community-based, multi-setting, multi-strategy intervention, OPAL (Obesity Prevention and Lifestyle), in increasing healthy weight prevalence in 9 to 11-year-olds.MethodsA quasi-experimental repeated cross-sectional design was employed. This paper reports on the anthropometric, health-related quality of life (HRQoL) and behaviour outcomes of primary school children (9–11 years) after 2–3 years of intervention delivery. Consenting children from primary schools (20 intervention communities, INT; 20 matched comparison communities, COMP) completed self-report questionnaires on diet, activity and screen time behaviours. HRQoL was measured using the Child Health Utility 9D. Body Mass Index (BMI) z-score and weight status were determined from children’s measured height and weight. A multilevel mixed-effects model, accounting for clustering in schools, was implemented to determine intervention effect. Sequential Bonferroni adjustment was used to allow for multiple comparisons of the secondary outcomes.ResultsAt baseline and final, respectively, 2611 and 1873 children completed questionnaires and 2353 and 1760 had anthropometric measures taken. The prevalence of children with healthy weight did not significantly change over time in INT (OR 1.11, 95%CI 0.92–1.35, p = 0.27) or COMP (OR 0.85, 95%CI 0.68–1.06, p = 0.14). Although changes in the likelihood of obesity, BMI z-score and HRQoL favoured the INT group, the differences were not significant after Bonferroni adjustment. There were also no significant differences between groups at final for behavioural outcomes.ConclusionsOPAL did not have a significant impact on the proportion of 9 to 11-year-olds in the healthy weight range, nor children’s BMI z-score, HRQoL and behaviours. Long-term, flexible community-based program evaluation approaches are required .Trial registrationACTRN12616000477426 (12th April 2016, retrospectively registered).

Does compliance with healthy lifestyle behaviours cluster within individuals in Australian primary school-aged children?

The 3 "movement behaviours" of sleep, screen time, and physical activity are associated with a wide range of health outcomes in children. This study examined whether these behaviours cluster together within individuals in Australian primary school children. Three datasets including 4,449 9- to 11-year-old children were interrogated-(a) Obesity Prevention and Lifestyle (OPAL), (b) the International Study of Children, Obesity, Lifestyle and Environment (ISCOLE), and (c) the National Children's Nutrition and Physical Activity Survey (NCNPAS). The surveys measured movement behaviours using different instruments (accelerometry, use of time recall, and questionnaires) and different operationalizations of compliance. Observed frequencies of compliance with various combinations of guidelines were compared with expected frequencies based on the assumption of independence, using chi-square tests. Compliance with the sleep guidelines was relatively high (72%, 75%, and 79% in the OPAL, ISCOLE, and NCNPAS datasets, respectively), and compliance with the screen (18%, 35%, and 22%) and physical activity (33%, 57%, and 87%) guidelines was generally lower. Against expectation, there was no evidence of clustering in any of the datasets (p>.99). Compliance with movement behaviour guidelines does not cluster within individuals in 9- to 11-year-old Australian children. It may be unlikely that fostering compliance with one guideline will have a flow-on effect to the others. Temporal trade-offs (i.e., the need to choose one movement behaviour above another) in the 24-hr day may contribute to the lack of clustering.

Partnerships in obesity prevention: maximising co-benefits.

Issue addressed Partnerships were used to increase healthy eating and active living in children for the Obesity Prevention and Lifestyle (OPAL) program, a systems-wide, community-based childhood obesity prevention program in South Australia. This part of the multi-component evaluation examines stakeholders' perceptions of how OPAL staff worked in partnership and factors contributing to strong partnerships. Methods Pre- and post-interviews and focus groups with multi-sector stakeholders (n=131) across six OPAL communities were analysed using NVivo8 qualitative data analysis software. Results Stakeholders reflected positively on projects developed in partnership with OPAL, reporting that staff worked to establish co-benefits. They identified several factors that contributed to the strengthening of partnerships: staff skills, visibility, resources and sustainability. Conclusions Rather than implementing projects with stakeholders with shared organisational goals, local shared projects were implemented that included a breadth of co-benefits, allowing multi-sector stakeholders to meet their own organisational goals. Practitioners who have the capacity to be flexible, persistent, knowledgeable and skilled communicators are required to negotiate projects, achieving benefit for both health and stakeholders' organisational goals. So what? Engaging in partnership practice to broker co-benefits at the micro or program level has been an effective model for community engagement and change in OPAL. It foregrounds the need for the inclusion of value to partners, which differs from situations in which organisations come together around common goals.

Assessing change in perceived community leadership readiness in the Obesity Prevention and Lifestyle program.

Issue addressed The context of community-based childhood obesity prevention programs can influence the effects of these intervention programs. Leadership readiness for community mobilisation for childhood obesity prevention is one such contextual factor. This study assessed perceived community leadership readiness (PCLR) at two time points in a state-wide, multisite community-based childhood obesity prevention program. Methods PCLR was assessed across 168 suburbs of 20 intervention communities participating in South Australia's Obesity Prevention and Lifestyle (OPAL) program. Using a validated online PCLR tool, four key respondents from each community rated each suburb within their respective community on a nine-point scale for baseline and 2015. Average PCLR and change scores were calculated using the general linear model with suburbs nested in communities. Relationships between demographic variables and change in PCLR were evaluated using multiple regression. Ease of survey use was also assessed. Results Average PCLR increased between baseline (3.51, s.d.=0.82) and 2015 (5.23, s.d.=0.89). PCLR rose in 18 of 20 intervention communities. PCLR was inversely associated with suburb population size (r2=0.03, P=0.03, β=-0.25) and positively associated with intervention duration (r2 change=0.08, P=0.00, β=0.29). Only 8% of survey respondents considered the online assessment tool difficult to use. Conclusions PCLR increased over the course of the OPAL intervention. PCLR varied between and within communities. Online assessment of PCLR has utility for multisite program evaluations. So what? Use of a novel, resource-efficient online tool to measure the key contextual factors of PCLR has enabled a better understanding of the success and generalisability of the OPAL program.

Prevalence and socio-economic distribution of eating, physical activity and sedentary behaviour among South Australian children in urban and rural communities: baseline findings from the OPAL evaluation

ObjectiveTo identify current prevalence and sociodemographic distribution of adherence to national diet and physical activity and sedentary behaviour guidelines among Australian primary school children. Study designCross-sectional survey of children (n = 4637, 9–11 years) participating at baseline in the South Australian Obesity Prevention and Lifestyle (OPAL) programme evaluation. MethodsSelf-reported diet, physical activity (PA) and screen time (ST) behaviours were assessed via questionnaire. Children were classified as meeting or not meeting each guideline (two or more serves of fruit, five or more serves of vegetables, two or less serves of discretionary food, ≥60 min of PA, and ≤2 h of ST per day). ResultsAlthough 65% of children met fruit recommendations, only 22% met vegetable recommendations (17% consumed no vegetables). Approximately one-quarter (28%) of children met discretionary food recommendations. Only 17% of children met the ST recommendations and 33% met PA recommendations. Less than 1% of children met all five recommendations. Rural children were more likely to meet both PA (OR = 1.45, 95% CI: 1.21–1.74, P < 0.001) and ST (OR = 1.37, 95% CI: 1.14–1.66, P < 0.01) recommendations than urban counterparts. Children at least socio-economic disadvantage performed better than those at greatest disadvantage for most behaviours. ConclusionImprovement in Australian children's diet and physical activity and sedentary behaviours, particularly urban children and those at greatest socio-economic disadvantage, is urgently warranted.

OPALesence: Epistemological pluralism in the evaluation of a systems-wide childhood obesity prevention program

The evaluation of complex systems-wide public health interventions requires evaluation research that is underpinned by theory. This article presents and discusses the trans-disciplinary evaluation research framework developed to support the evaluation of a South Australian program called OPAL (Obesity Prevention and Lifestyle). The aim is to provide insights into the research design, methods and implementation of the evaluation and contribute to the debate on how to evaluate community-based interventions with complicated and complex aspects. In an attempt to capture the complexity of childhood obesity and the intervention, the OPAL evaluation research employs post positivist, interpretive and critical epistemologies, valuing epistemological pluralism. Each component of the multi-phase mixed methods evaluation captures different yet complementary information concerning the context, process, cost effectiveness and outcomes providing a more complete understanding of the impacts of the complex program. Evaluation research is not without challenges. Some of the tensions and challenges that arose in the establishment, planning and conduct of the OPAL program and evaluation are discussed.

Practitioner insights on obesity prevention: the voice of South Australian OPAL workers.

Knowledge based on science has been central to implementing community-based childhood obesity prevention interventions. The art of practitioner wisdom is equally critical to ensure locally relevant responses. In South Australia (SA), the OPAL (Obesity Prevention and Lifestyle) program has been implemented to reduce childhood obesity across 20 communities reaching nearly one quarter of the state's population. Staff from across the State come together at regular intervals to share practice challenges and insights and refine the model of practice. Over a 3-year period 12 reflective practice workshops were held with OPAL staff (n = 46). OPAL staff were guided by an external facilitator using inquiring questions to reflect on their health promotion practice within local government. Three themes were identified as central within the reflections. The first theme is shared clarity through the OPAL obesity prevention model highlighting the importance of working to a clearly articulated, holistic obesity prevention model. The second theme is practitioner skill and sensitivity required to implement the model and deal with the 'politics' of obesity prevention. The final theme is the power of relationships as intrinsic to effective community based health promotion. Insights into the daily practices and reflections from obesity prevention practitioners are shared to shed light on the skills required to contribute to individual and social change. OPAL staff co-authored this paper.

Community-based obesity prevention in Australia: Background, methods and recruitment outcomes for the evaluation of the effectiveness of OPAL (Obesity Prevention and Lifestyle)

Background: The Obesity Prevention and Lifestyle (OPAL) intervention program targets families and communities to improve children’s eating and physical activity patterns. We outline the quantitative evaluation design and recruitment results for baseline data collection. Methods: A longitudinal quasi-experimental design, with baseline data collection and five-year follow-up. Participants targeted are children, parents, and school principals/directors from primary, secondary/R-12 schools, pre-schools, childcare and out-of-school-hours-care (OSHC) centers in 20 selected communities across South Australia (SA), and one in the Northern Territory (NT). A total of 277 (262 SA, 15 NT) schools participated; 4860 9-11 year olds and 1164 12-16 year olds completed a questionnaire. Anthropometric measures were taken from 5531 students; 6552 parents, 276 pre/school/childcare directors, 139 OSHC directors and 237 principals completed questionnaires. Data include measurements of child participants’ weight/height/waist circumference; paper-based/online surveys of informants in early childhood, primary/secondary school and community settings; and secondary growth check data for 4-5 year old children. Serial cross-sectional analyses will compare intervention to matched comparison communities. Results: Overall school response rate was 50%. Student response rates were 20-22% and 11-13% (questionnaires and measurements respectively); 14-21% of parents, 49-55% of directors, and 26-44% of principals completed and returned questionnaires. Changes to child weight status; eating practices; sleep, physical activity/sedentary behaviors; physical environments; community capacity; and economic evaluation (Quality Adjusted Life year gain) will examine program effectiveness. Conclusions: As the most significant program of its kind in Australia, OPAL will contribute to obesity prevention efforts on an international scale.

Assessing implementation fidelity and adaptation in a community-based childhood obesity prevention intervention

Little research has assessed the fidelity, adaptation or integrity of activities implemented within community-based obesity prevention initiatives. To address this gap, a mixed-method process evaluation was undertaken in the context of the South Australian Obesity Prevention and Lifestyle (OPAL) initiative. An ecological coding procedure assessed fidelity and adaptation of activity settings, targets and strategies implemented in the second year of four communities. Implementation integrity reflected fidelity and adaptation to local context, whereas efforts resulting in significant deviations from the original plan were deemed to lack fidelity and integrity. Staff implemented 284 strategies in 205 projects. Results show that 68.3 and 2.1% of strategies were implemented with fidelity or adapted, respectively. Overall, 70.4% of all strategies were implemented with integrity. Staff experienced barriers with 29.6% of strategies. Chi-square analyses show statistically significant associations between implementation integrity and strategy type, intervention and behavioural targets. These relationships are weak to modest. The strongest relationship was found between implementation integrity and proximal target. Staff experienced implementation barriers at the coalition, policy, organization, interpersonal and community levels. The greatest range of barriers was encountered working with organizations. To overcome these barriers, staff took greater ownership, invested more time, persisted and allocated more financial resources.

Mapping the program logic for the South Australia Obesity Prevention and Lifestyle (OPAL) initiative

Mapping the program logic for the South Australia Obesity Prevention and Lifestyle (OPAL) initiative