Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Community interventions—planning for sustainability
integrated into other systems and structures and build
on other areas of the community ’ s capacity. 6
Principles of e valuation
Evaluation is covered in Chapter 19 in detail, but
some principles as they apply to the planning stages
are outlined here. It is very important that the
approach and framework for evaluation are developed
concurrently in the program planning phase. 12 The
capacity to conduct the evaluation needs to match
the size and scope of the evaluation intended. The
framework or evaluation plan should contain options
for measuring process, impact and outcomes of
the implementation. Outcome and impact evaluation
correspond to changes in the program ’ s aims and
objectives. For well - evaluated demonstration projects,
these would include changes in anthropometry,
behaviors (skills, knowledge), environments and
4
capacity. Ideally, an economic evaluation should
be conducted to contribute to the evidence of cost –
effectiveness and optimal implementation. The use of
standard measures and tools will enable a com parison
with other programs/projects. Documenting lessons
learnt is valuable in dissemination and can contribute
to the evidence of what does, or does not, work. The
context for evaluation needs consideration as current
organizational, policy, and community contextual
factors can have a major impact on the outcomes.
Evaluation findings need to be disseminated within
the community in the first instance and this should
occur as the findings become available so that knowledge
transfer can be applied back in the community.
At the next level, translation of evidence from research
into policy and practice is required for a continuous
response to obesity at the public health policy level.
Key c hallenges in
e stablishing and s ustaining
c ommunity i nterventions
The very nature of community - based interventions
creates challenges because they are inevitably complex
to implement and evaluate, they are always contextual,
and are usually poorly resourced. However, a few
particular challenges in existing and future commu-
nity approaches to obesity prevention warrant special
mention.
Sufficient i nvestment in p rograms
and e valuations
The time lag from the early signs of the obesity epidemic
in the early 1980s to the first phase of community
- based demonstration projects in a few countries
in the mid - 2000s was substantial and, even now, the
funding investment to build the evidence base for
effectiveness has remained very low. Government -
funded programs traditionally provide little funding
for evaluation (which may cost as much as the program
itself if effectiveness and cost – effectiveness are to be
measured) and research - funded programs tend to pay
little attention to program sustainability and integration
into existing services.
Complexity of p rogram i mplementation
and e valuation
There are many different approaches to program
implementation but they all encounter the complexity
of having to juggle multiple partners, agendas, funding
constraints, and personal and organizational relationships.
There is no simple formula for negotiating this
complexity and the mix will be different for each
context. Similarly, the evaluation of multi - sector
intervention programs which are under community
control are complex, especially when potential comparison
populations are exposed to a variety of other
local, state and national programs to promote healthy
eating and physical activity. Quasi - experimental
designs can be used for program evaluation but they
all carry higher risks of arriving at false negative or
false positive conclusions than the more rigorous controlled
trials that randomize individuals or clusters
(e.g. schools).
Incorporating s ocio - c ultural c omponents
There are significant differences in obesity prevalence
rates across ethnic groups and this indicates that
socio - cultural factors must be considered in any
implementation program in those groups. 20,21 For
example, if the over - provision and over - consumption
of food is a fundamental expression of the underlying
cultural values of showing care, respect and
love between people, how can obesity prevention
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