Assessing community readiness for overweight and obesity prevention in pre-adolescent girls:a case study

BACKGROUND: Childhood overweight and obesity is a global public health concern. For girls in particular, being overweight or obese during pre-adolescence (aged 7–11 years) has intergenerational implications for both the mother and her future offspring. In the United Kingdom (UK) there is increasing interest in community targeted interventions but less is known about how to tailor these approaches to the needs of the community. This study applied the Community Readiness Model (CRM), for the first time in the UK, to demonstrate its applicability in designing tailored interventions. METHODS: Community readiness assessment was conducted using semi-structured key informant interviews. The community’s key informants were identified through focus groups with pre-adolescent girls. The interviews addressed the community’s efforts; community knowledge of the efforts; leadership; community climate; community knowledge of the issue and resources available to support the issue. Interviews were conducted until the point of theoretical saturation and questions were asked separately regarding physical activity (PA) and healthy eating and drinking (HED) behaviours. The interviews were transcribed verbatim and were firstly analysed thematically and then scored using the assessment guidelines produced by the CRM authors. RESULTS: Readiness in this community was higher for PA than for HED behaviours. The lowest scores related to the community’s ’resources’ and the ’community knowledge of the issue’; affirming these two issues as the most appropriate initial targets for intervention. In terms of resources, there is also a need for resources to support the development of HED efforts beyond the school. Investment in greater physical education training for primary school teachers was also identified as an intervention priority. To address the community’s knowledge of the issue, raising the awareness of the prevalence of pre-adolescent girls’ health behaviours is a priority at the local community level. Inconsistent school approaches contributed to tensions between schools and parents regarding school food policies. CONCLUSIONS: This study has identified the readiness level within a UK community to address the behaviours related to overweight and obesity prevention in pre-adolescent girls. The focus of an intervention in this community should initially be resources and raising awareness of the issue within the community

The role of community readiness in the prevention of overweight and obesity in pre-adolescent girls

Overweight and obesity prevention efforts focused on pre-adolescent girls are justified because the health of future mothers can significantly impact the health of their future offspring. Aims and Objectives This thesis aimed to investigate the role of community readiness in the prevention of overweight and obesity in pre-adolescent girls within the Charnwood Borough (Leicestershire) community. Specifically the objectives of this research were to: 1) further the understanding of the concept of community , 2) identify, using focus groups, the key informants and other ecological influences acting on pre-adolescent girls health behaviours, 3) employ the Community Readiness Model (CRM), using key informant interviews, to assess the Charnwood Borough community s knowledge, awareness and readiness to adopt behaviours associated with the prevention of overweight and obesity in pre-adolescent girls, 4) evaluate the usefulness of the CRM for this task and 5) form recommendations for a tailored intervention. Methods This research used focus groups with pre-adolescent girls to identify the key informants who influence their lifestyle choices regarding dietary and physical activity behaviours. The study recruited 56 female participants aged between 6-11 years from 8 primary schools. In total 13 focus groups with between 2 to 7 participants per group were performed. To assess the level of community readiness, 33 key informants identified as informing the health behaviours of pre-adolescent girls were recruited. Semi-structured interviews followed an adapted version of the CRM. The model consists of six dimensions: community efforts; community knowledge of efforts; leadership; community climate; community knowledge of the issue and resources which are scored on a scale of 1 (no awareness) to 9 (high level of community readiness). The average of these scores is the community readiness stage. Findings In relation to the first objective, the definition of a community given by those residing in the Charnwood Borough community included: people and groups of people (e.g. school; religious and parents community groups); characteristics (i.e. geographical area; where people reside; buildings; institutions and the size of the community); sense of belonging and the attempt to improve the community for its members. By valuing the perspectives of pre-adolescent girls, a deepened understanding of the broad range of key informants (Dinner staff, Doctors and dentists, Head teachers, Girl Guide leaders, Government, Grandparents, Neighbours, Parents, Peer group, School cooks, Shop keepers, Siblings, Sports Coaches and Teachers) acting on their health behaviours was achieved (Objective 2). The community readiness score relating to healthy eating and drinking corresponded to the Preparation Stage (Objective 3), whereby influential community members have begun planning efforts by deciding what to do and who will do it and the community offers modest support of efforts promoting healthy dietary behaviours. The community readiness score for physical activity was higher corresponding to the Initiation Stage where there is enough information available to justify efforts and activities are underway to support healthy physical activity behaviours. Qualitatively, the key findings from applying the CRM are that: the effectiveness of community initiatives promoting healthy behaviours can be improved; there are varying levels of concern and awareness regarding unhealthy behaviours and child weight status in the community; social disparities are perceived to exist in community health behaviours; communication between schools and parents are seen as important for the success of school policies; parental attitudes and behaviours inform child behaviours; enjoyment is an important predictor of girls activity levels and aspects of the Charnwood Borough s environment do not support healthy behaviours. The CRM was shown to be an appropriate tool for assessing community readiness (Objective 4) providing the qualitative strengths of the model are emphasised. The community readiness score and the qualitative analysis informed the recommendations for an intervention in the Charnwood Borough (Objective 5). Key aspects of these recommendations include: raising the community s awareness of pre-adolescent girls health behaviours; ensuring all initiatives are accessible and appealing to low income families by working directly with these groups; fostering a greater sense of community through increased community cohesion and social interaction; placing social interaction and enjoyment at the centre of all activities, and attempting to make the healthier option the easier choice through modifications to the environment. Conclusions This thesis is the first to apply the Community Readiness Model to the prevention of overweight and obesity in pre-adolescent girls in the UK and has demonstrated the value of applying a community readiness assessment prior to the implementation of interventions

The contribution of media analysis to the evaluation of environmental interventions: the commuting and health in Cambridge study.

BACKGROUND: Media content can increase awareness of, and shape interactions with, public health interventions. As part of a natural experimental evaluation of the travel, physical activity and health impacts of the Cambridgeshire Guided Busway, we analysed print and social media discourse and interview data to understand the nature of new transport infrastructure and how it was experienced. METHODS: Newspaper articles were systematically retrieved from the LexisNexis database and tweets were identified from an online archive. Interviews were conducted as part of the larger evaluation study with 38 adults. Inductive thematic analysis was performed and comparisons were drawn between datasets. RESULTS: The findings are discussed in relation to five themes. First, an understanding of the intervention context and how the intervention was experienced was developed through accounts of events occurring pre and post the busway's opening. Second, the media captured the dynamic nature of the intervention. Third, the media constructed idealised portrayals of the anticipated busway which in some cases were contradicted by the impact of the busway on the existing context and people's lived experiences. Fourth, differential media coverage of the intervention components suggested that a lesser value was placed on promoting active travel compared with public transport. Lastly, interview data provided support for the hypothesis that the media increased awareness of the busway and served as a frame of reference for constructing expectations and comparing experiences. CONCLUSIONS: This analysis has contributed to the wider evaluation of the busway, helping to understand its nature and implementation and informing hypotheses about how the local population interact with the infrastructure by attending to the significance of representations in the media

The contribution of media analysis to the evaluation of environmental interventions: the commuting and health in Cambridge study.

BACKGROUND: Media content can increase awareness of, and shape interactions with, public health interventions. As part of a natural experimental evaluation of the travel, physical activity and health impacts of the Cambridgeshire Guided Busway, we analysed print and social media discourse and interview data to understand the nature of new transport infrastructure and how it was experienced. METHODS: Newspaper articles were systematically retrieved from the LexisNexis database and tweets were identified from an online archive. Interviews were conducted as part of the larger evaluation study with 38 adults. Inductive thematic analysis was performed and comparisons were drawn between datasets. RESULTS: The findings are discussed in relation to five themes. First, an understanding of the intervention context and how the intervention was experienced was developed through accounts of events occurring pre and post the busway's opening. Second, the media captured the dynamic nature of the intervention. Third, the media constructed idealised portrayals of the anticipated busway which in some cases were contradicted by the impact of the busway on the existing context and people's lived experiences. Fourth, differential media coverage of the intervention components suggested that a lesser value was placed on promoting active travel compared with public transport. Lastly, interview data provided support for the hypothesis that the media increased awareness of the busway and served as a frame of reference for constructing expectations and comparing experiences. CONCLUSIONS: This analysis has contributed to the wider evaluation of the busway, helping to understand its nature and implementation and informing hypotheses about how the local population interact with the infrastructure by attending to the significance of representations in the media.Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The study is now funded by the National Institute for Health Research Public Health Research programme (project number 09/3001/06: see http://www.phr.nihr.ac.uk/funded_projects). DO is also funded by the Medical Research Council [Unit programme number MC_UU_12015/6].This is the final public version, also available at http://www.biomedcentral.com/1471-2458/14/482#ack. It's available under a CC BY licence

Criticality in a Hadron Resonance Gas model with the van der Waals interaction

The van der Waals interaction is implemented in a Hadron Resonance Gas model. It is shown that this model can describe Lattice QCD data of different thermodynamical quantities satisfactorily with the van der Waals parameters $a = 1250 \pm 150$ MeV fm$^3$ and $r = 0.7 \pm 0.05$ fm. Further, a phase transition is observed in this model with the critical point at temperature, $T = 62.1$ MeV and baryon chemical potential, $\mu_B = 708$ MeV

From the concrete to the intangible: understanding the diverse experiences and impacts of new transport infrastructure.

BACKGROUND: Changes to the environment that support active travel have the potential to increase population physical activity. The Cambridgeshire Guided Busway is an example of such an intervention that provides new traffic-free infrastructure for walking, cycling and public transport. This qualitative investigation explored the diverse experiences of new transport infrastructure and its impacts on active travel behaviours. METHODS: Thirty-eight adult participants from the Commuting and Health in Cambridge natural experimental study were purposively selected according to their demographic and travel behaviour change characteristics and invited to participate in semi-structured interviews between February and June 2013. A mixed-method, following-a-thread approach was used to construct two contrasting vignettes (stories) to which the participants were asked to respond as part of the interviews. Inductive thematic qualitative analysis of the interview data was performed with the aid of QSR NVivo8. RESULTS: Perceptions of the busway's attributes were important in shaping responses to it. Some participants rarely considered the new transport infrastructure or described it as unappealing because of its inaccessibility or inconvenient routing. Others located more conveniently for access points experienced the new infrastructure as an attractive travel option. Likewise, the guided buses and adjacent path presented ambiguous spaces which were received in different ways, depending on travel preferences. While new features such as on board internet access or off-road cycling were appreciated, shortcomings such as overcrowded buses or a lack of path lighting were barriers to use. The process of adapting to the environmental change was discussed in terms of planning and trialling new behaviours. The establishment of the busway in commuting patterns appeared to be influenced by whether the anticipated benefits of change were realised. CONCLUSIONS: This study examined the diverse responses to an environmental intervention that may help to explain small or conflicting aggregate effects in quantitative outcome evaluation studies. Place and space features, including accessibility, convenience, pleasantness and safety relative to the alternative options were important for the acceptance of the busway. Our findings show how environmental change supporting active travel and public transport can encourage behaviour change for some people in certain circumstances

A critical discussion of the Community Readiness Model using a case study of childhood obesity prevention in England

Recent reforms to the public health system in England aim to generate co-ordinated action between local authorities, healthcare systems and communities to target local health priorities. To support this effort, researchers must contribute and evaluate appropriate strategies for designing interventions tailored to community-specific needs. One strategy is to apply the Community Readiness Model (CRM), which uses key informant interviews to assess a community's readiness to address local issues. This article presents a critical discussion of the CRM developed from a case study of obesity prevention in pre-adolescent girls within a community in the United Kingdom. Data were collected between February and November 2011. We offer lessons learnt and recommendations relating to (i) modifications to the interview guide; (ii) key informant identification; (iii) conducting interviews to theoretical saturation; (iv) using key informants to define their community; (v) key informant's ability to respond on behalf of the community; (vi) using a qualitative model with a quantitative scoring system; and (vii) the optimum application of transcript scoring. In conclusion, the CRM can help researchers, health professionals and local authorities identify the priorities of a community. It is recommended that users of the model be careful to identify and recruit suitable key informants with the help of the community under study, select an appropriate ‘community’ and utilise the qualitative findings to strengthen the interpretation of the readiness score

Development of a universal approach to increase physical activity among adolescents: the GoActive intervention.

OBJECTIVES: To develop a physical activity (PA) promotion intervention for adolescents using a process addressing gaps in the literature while considering participant engagement. We describe the initial development stages; (1) existing evidence, (2) large scale opinion gathering and (3) developmental qualitative work, aiming (A) to gain insight into how to increase PA among the whole of year 9 (13-14 years-old) by identifying elements for intervention inclusion (B) to improve participant engagement and (C) to develop and refine programme design. METHODS: Relevant systematic reviews and longitudinal analyses of change were examined. An intervention was developed iteratively with older adolescents (17.3 ± 0.5 years) and teachers, using the following process: (1) focus groups with (A) adolescents (n=26) and (B) teachers (n=4); (2) individual interviews (n=5) with inactive and shy adolescents focusing on engagement and programme acceptability. Qualitative data were analysed thematically. RESULTS: Limitations of the existing literature include lack of evidence on whole population approaches, limited adolescent involvement in intervention development, and poor participant engagement. Qualitative work suggested six themes which may encourage adolescents to do more PA; choice, novelty, mentorship, competition, rewards and flexibility. Teachers discussed time pressures as a barrier to encouraging adolescent PA and suggested between-class competition as a strategy. GoActive aims to increase PA through increased peer support, self-efficacy, group cohesion, self-esteem and friendship quality, and is implemented in tutor groups using a student-led tiered-leadership system. CONCLUSIONS: We have followed an evidence-based iterative approach to translate existing evidence into an adolescent PA promotion intervention. Qualitative work with adolescents and teachers supported intervention design and addressed lack of engagement with health promotion programmes within this age group. Future work will examine the feasibility and effectiveness of GoActive to increase PA among adolescents while monitoring potential negative effects. The approach developed is applicable to other population groups and health behaviours. TRIAL REGISTRATION NUMBER: ISRCTN31583496.Funding for this development study and the work of all authors was supported, wholly or in part, by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence (RES 590 28 0002). Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The work of Kirsten Corder, Joanna Kesten and Esther M F van Sluijs was supported by the Medical Research Council (MC_UU_ 12015/7 and MC_UU_12015/6).This is the final version of the article. It first appeared from the BMJ Publishing Group via http://dx.doi.org/10.1136/bmjopen-2015-00861

The potential yield of active play in the prevention of cancer

Literature has shown that participation in physical activity is associated with a reduction in the incidence of certain cancers. Physical activity levels across the life course are low. Since cellular damage from an inactive lifestyle accumulates over time, promoting physical activity from childhood is fundamental for cancer prevention. To date, interventions to promote physical activity in children have been unsuccessful over the long term. Physical activity can be accrued through several domains including sport and active play. Research suggests that sport participation and not active play tracks from childhood to adulthood. Active play is easier to promote because it does not necessitate a certain level of skill or competency, and is enjoyable. The purpose of the present paper is to encourage more research into all areas of active play to increase population physical activity levels across the life course and thus aid in the prevention of specific cancers