Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Evaluation of community-based obesity interventions
framework also helps to highlight the fact that in drug
research the majority of research effort and funding
goes into early stage basic science and pharmacological
research, to identify disease mechanisms and
potential ways to interrupt these mechanisms through
the identification of active pharmacological agents.
Only a small proportion of this research produces
candidate therapies for drug trials.
The early research stages require a wide range of
methods, which may include: epidemiological analysis
of primary or secondary data to identify key modifiable
correlates, including attitudes and mediating
psycho - social factors; interviews and/or focus groups
with key stakeholders and members of the target population
to identify causal factors and potential intervention
pathways; development of partnerships;
discussions with key experts in the field; systematic
review of the literature to identify potentially effective
interventions and/or eliminate or modify candidate
interventions that have previously been found unsuccessful.
As a result of this early pre - intervention
research and informed by theoretical perspectives
ideally drawn from a range of disciplines (see Box
19.3 ), the composition and rationale for a prototype
intervention can then be set out, identifying the key
changes the intervention will directly instigate, and
those that will be expected to follow as a result of the
intervention. It will often be useful to map this out as
a diagrammatic model, which will ideally include not
only the intervention components and expected outcomes
(as in an implementation model) but also a
description of the mechanisms of change, key mediating
factors and change mechanisms, and potential
positive and negative impacts and outcomes not
directly associated with the primary target variable.
Once the prototype intervention has been developed,
it is important to pilot test the intervention, or
at least key components of the intervention, with a
particular focus on its feasibility, acceptability and
delivery, and evidence of the hypothesized causal
processes being triggered as anticipated. This pilot
work will involve small samples and primarily qualitative
research methods, but may also involve quantitative
surveys among pilot study samples. An example
pilot investigation was that of the Free School Breakfast
Initiative in Wales, 18 where primarily qualitative case
study analysis of an initial sample of schools identified
important lessons for the modification of the scheme,
Box 19.3 Different f orms of
e xpertise
Comprehensive evaluations of complex community -
based studies need to be conducted by a transdisciplinary
team of researchers to address the complexity
in both the intervention and the evaluation. For
example, the fun ’ n healthy in Moreland! study has a
national team of investigators with expertise in obesity
research, physical activity measures, nutrition studies,
evaluation, community interventions, statistics, qualitative
and mixed method approaches, body image,
child and family eating habits, health economics, and
cultural competency. Their depth of knowledge in their
field of specialty and their interest in complex interventions
makes them ideally suited to joint consideration
of appropriate approaches and measures,
synthesis and development of new measures and
approaches, where necessary. 8 There are also strong
partnerships with policy, practice and public stakeholders
in various state and local government
departments.
However, this does not mean that the evaluation
should be “ expert - driven ” . 12 Instead, the engagement
of the community as partners and decision makers is
more likely to support the development of an appropriate
methodology and measures, will maximize the
reach of recruitment, assist in the development of in -
depth understandings of the data and meaningful findings,
and assist with community dissemination and
ownership of results. 29,30 In fun ’ n healthy in Moreland!,
the local community health service and the schools
were partners in the intervention and research study
with an active role in decision making, and cultural
groups and local community organisations provided
guidance and support. This approach is known as
community - based participatory research in which the
expertise of the community is recognized in respectful
partnerships that involve mutual knowledge exchange
and decisionaking at all stages of the research
process. 30,31
as well as identifying key issues to be addressed in the
subsequent larger - scale evaluation. Another example
was the Outreach School Garden Project implemented
in two remote indigenous school communities in
north-west Queensland, Australia.19 The evaluation
incorporated a descriptive qualitative approach supplemented
by some quantitative data to assess feasibility,
acceptability and capacity building.
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