A community based systems diagram of obesity causes

INTRODUCTION: Application of system thinking to the development, implementation and evaluation of childhood obesity prevention efforts represents the cutting edge of community-based prevention. We report on an approach to developing a system oriented community perspective on the causes of obesity. METHODS: Group model building sessions were conducted in a rural Australian community to address increasing childhood obesity. Stakeholders (n = 12) built a community model that progressed from connection circles to causal loop diagrams using scripts from the system dynamics literature. Participants began this work in identifying change over time in causes and effects of childhood obesity within their community. The initial causal loop diagram was then reviewed and elaborated by 50 community leaders over a full day session. RESULTS: The process created a causal loop diagram representing community perceptions of determinants and causes of obesity. The causal loop diagram can be broken down into four separate domains; social influences; fast food and junk food; participation in sport; and general physical activity. DISCUSSION: This causal loop diagram can provide the basis for community led planning of a prevention response that engages with multiple levels of existing settings and systems

Participant titles and roles.

<p>Participant titles and roles.</p

Connection circles for community causes of childhood obesity.

<p>Connection circles for community causes of childhood obesity.</p

Causal loop diagram of cause of childhood obesity in community.

<p>Causal loop diagram of cause of childhood obesity in community.</p

Causal loop diagram of Romp & Chomp.

<p>Causal loop diagram of Romp & Chomp.</p

Development and testing of a novel survey to assess Stakeholder-driven Community Diffusion of childhood obesity prevention efforts

Background: Involving groups of community stakeholders (e.g., steering committees) to lead community-wide health interventions appears to support multiple outcomes ranging from policy and systems change to individual biology. While numerous tools are available to measure stakeholder characteristics, many lack detail on reliability and validity, are not context specific, and may not be sensitive enough to capture change over time. This study describes the development and reliability of a novel survey to measure Stakeholder-driven Community Diffusion via assessment of stakeholders’ social networks, knowledge, and engagement about childhood obesity prevention. Methods: This study was completed in three phases. Phase 1 included conceptualization and online survey development through literature reviews and expert input. Phase 2 included a retrospective study with stakeholders from two completed whole-of-community interventions. Between May–October 2015, 21 stakeholders from the Shape Up Somerville and Romp & Chomp interventions recalled their social networks, knowledge, and engagement pre-post intervention. We also assessed one-week test-retest reliability of knowledge and engagement survey modules among Shape Up Somerville respondents. Phase 3 included survey modifications and a second prospective reliability assessment. Test-retest reliability was assessed in May 2016 among 13 stakeholders involved in ongoing interventions in Victoria, Australia. Results: In Phase 1, we developed a survey with 7, 20 and 50 items for the social networks, knowledge, and engagement survey modules, respectively. In the Phase 2 retrospective study, Shape Up Somerville and Romp & Chomp networks included 99 and 54 individuals. Pre-post Shape Up Somerville and Romp & Chomp mean knowledge scores increased by 3.5 points (95% CI: 0.35–6.72) and (− 0.42–7.42). Engagement scores did not change significantly (Shape Up Somerville: 1.1 points (− 0.55–2.73); Romp & Chomp: 0.7 points (− 0.43–1.73)). Intraclass correlation coefficients (ICCs) for knowledge and engagement were 0.88 (0.67–0.97) and 0.97 (0.89–0.99). In Phase 3, the modified knowledge and engagement survey modules included 18 and 25 items, respectively. Knowledge and engagement ICCs were 0.84 (0.62–0.95) and 0.58 (0.23–0.86). Conclusions: The survey measures upstream stakeholder properties—social networks, knowledge, and engagement—with good test-retest reliability. Future research related to Stakeholder-driven Community Diffusion should focus on prospective change and survey validation for intervention effectiveness. Electronic supplementary material The online version of this article (10.1186/s12889-018-5588-1) contains supplementary material, which is available to authorized users

Additional file 1: of Development and testing of a novel survey to assess Stakeholder-driven Community Diffusion of childhood obesity prevention efforts

Table S1A. Engagement literature review and scale development. (DOCX 54 kb

Additional file 4: of Development and testing of a novel survey to assess Stakeholder-driven Community Diffusion of childhood obesity prevention efforts

Table S3C1-C2. Phase 3 prospective per-item knowledge and engagement reliability results (n = 13 paired responses). Data from test-retest surveys administered online two weeks apart in May 2016: members of the SEA Change and GenR8 Change coalitions in Victoria, Australia. (DOCX 28 kb

Additional file 3: of Development and testing of a novel survey to assess Stakeholder-driven Community Diffusion of childhood obesity prevention efforts

Appendix. Example COMPACT Stakeholder-driven Community Diffusion Survey. (DOCX 39 kb