Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 26
consider and build on the strengths of existing activities
and partnerships in the community and use a
mix of evidence - based and innovative approaches. 16
Active change processes (theories of change) need to
underpin the action plan to influence environments
(settings), organizations, policies and individuals.
The use of program logic models can assist all key
stakeholders to understand the components and outcomes
to the planned program. The path between
goals, objectives and strategies are defined and the
fundamentals of the program design can be checked
and deemed logical. 17
Governance and m anagement s tructures
Good program management is required to implement
the action plan. Governance structures and lines of
accountability are essential. A structured approach to
project management ensures accountability, progress
and quality, and implements risk management and
problem - solving strategies among project staff and
key stakeholders. Partnership and organizational relationships,
and lines of communication need to be
specified. Progress reports/updates to funding bodies
and key stakeholders are also important communication
tools.
Principles of i mplementation
and s ustainability
Sustainability needs to be built into the action plan
from the outset. The natural tendency for actions to
be dominated by awareness - raising activities, one - off
events, and educational strategies needs to be countered
by a conscious effort to implement the more
sustainable strategies of capacity building strategies
(above), creating supportive policies, environments
and social norms. Attention to the quality of implementation
is also critical.
Policies and e nvironmental c hange
Policies are the “ set of rules ” that influence the
environments, which in turn influence behaviors. 1
Settings - based food service policies are a good
example. School food policies that take junk food out
of the school canteens, or a workplace cafeteria policy
that makes low - fat milk the default choice (i.e. auto-
matic option unless otherwise specified) for coffee,
not only make the healthy choices easier but also
signal what those healthy choices are. The policy influences
the behavior indirectly by influencing obesogenic
environments and sending health behavior signals.
This is in contrast to seat belt or smoking policies and
laws which directly mandate behaviors.
Social c hange
Social marketing is the application of marketing concepts,
tools and techniques to any social issue. 18 Social
marketing not only targets individual behavior change,
but also attempts to bring about changes in the social
and structural factors that impinge on an individual
and their opportunities, capacities and right to a
healthy and fulfilling life. The emphasis of social marketing
should target community leaders who have the
power and influence to make major institutional
policy and legislative changes rather than focusing on
voluntary health behaviors to individuals in the
general population. Changing cultural norms is often
difficult and controversial, but norms have powerful,
sustainable effects on behaviors. Using social marketing
for obesity prevention requires an integrated
approach in the project ’ s action plan and communication
plan. The testing of approaches, resources,
messages and images with or for the target group is
imperative to ensure appropriateness, acceptability
and comprehensibility.
Quality of i mplementation
Because little has been published on the implementation
of obesity prevention efforts or the extent of
effort required for change, principles for optimal
implementation are still being developed. The use of
process evaluation, to assess fidelity, completeness,
exposure, satisfaction and reach of intervention activities,
provides a good monitoring system. 19 The review
and adjustment of implementation can then be
achieved. Implementation efforts also need to build
the capacity of all key stakeholders to ensure actions/
activities are ongoing and sustained.
Responding to opportunities, often unexpected
ones (e.g. emerging community requests, linking with
new programs or partners) can assist with sustainability.
This is especially the case where initiatives are
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