Jan 16, 2003 - Social Marketing Plan. 25 .... Table 1 Initial action plan for Be Active Eat Well project . .... the media and other social marketing opportunities.
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DDeakin Research Online Research Online This is the published version (version of record) of: Simmons, A., Sanigorski, A. M., Cuttler, R., Brennan, M., Kremer, P, Mathews, L and Swinburn, B. A. 2009, Nutrition and physical activity in children and adolescents : report 6 : lessons learned from Colac's be active eat well project (2002-6) Department of Human Services Victoria, Melbourne, Vic. Available from Deakin Research Online: http://hdl.handle.net/10536/DRO/DU:30021654 Reproduced with the kind permission of the copyright owner . Copyright : 2009, Department of Human Services (Victoria)
Nutrition and Physical Activity in Children and Adolescents Barwon-South Western Region Sentinel Site Series Report 6: Lessons learned from Colac’s Be Active Eat Well Project (2002-2006)
Report prepared for Department of Human Services (Victoria)
By the WHO Collaborating Centre for Obesity Prevention Deakin University
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Copyright protects this publication. This report was produced for Department of Human Services (Victoria) ….
ISBN No XXXX
Simmons A., Sanigorski AM, Cuttler R, Brennan M, Kremer P, Mathews L, & Swinburn BA (2008) Nutrition and Physical Activity in Children and Adolescents. Barwon-South Western Region. Sentinel Site Series. Report 6: Lessons learned from Colac’s Be Active Eat Well project (2002-6): Department of Human Services (Victoria)
Acknowledgements The work contained in this report, and the others in this series, represents an enormous effort from many people across a number of organisations. All of their efforts and contributions are gratefully acknowledged. Funding: The implementation of the three projects (Romp & Chomp, Be Active Eat Well, It’s Your Move!) and the support and evaluation provided by Deakin University has been funded from many sources, including the Victorian Department of Human Services, Australian Government Department of Health and Ageing, National Health and Medical Research Council, Australian Research Council, VicHealth, City of Greater Geelong, Barwon Health, Alcoa, Barwon Primary Care Forum, and Deakin University. Program implementation: Several organisations and staff have contributed to the implementation of these projects. Romp & Chomp: Barwon Health, City of Greater Geelong, Geelong Kindergarten Association, and Leisure Networks with significant input from Mark Brennan, Maree Crellin, Lisa De Majo, Kathleen Doole, Debbie Elea, Frank Giggins, Janet Park, Susan Parker, Sharon Sharp, Michael Smith, Karen Stagnitti, Janet Torode, Louise Van Herwerden and others. Be Active Eat Well: Colac Area Health, Colac Otway Shire, the primary schools and kindergartens in Colac and the Barwon South-Western Region, Victorian Government Department of Human Services (including Barwon South-Western Regional Office), Leisure Networks, Neighbourhood Renewal with significant input from Simon Baker, Tracey Bayne, Mark Brennan, Tim Bryar, Brooke Connolly, Ruth Cuttler, Juli Farquhar, Greg Fletcher, Christine Gurrie, Steve Illingworth, Di Leverret, Pauline Maunsell, Jorja Millar, Margaret Scanlon, Jason Thompson, John Townsend, Megan Trigg, Rachel Wood and others. It’s Your Move!: the secondary schools in Geelong, Bellarine and the Barwon South-Western Region, and the City of Greater Geelong with significant input from Sue Blackett, Leanne Denny, Kerryn Fearnsides, Christine Green, Sonia Kinsey, Kirsty Licheni, Louise Mathews, Kate Meadows, Lauren Reading, Lyndal Taylor and others Kristina Basile, Kathy McConnell, Helen Walsh, Rowland Watson and others from the Victorian Government Department of Human Services, and Virginia Cherry from the Department of Education and Early Childhood Development significantly contributed to all projects. The contribution of the participating schools, early childhood settings, parents, and children in the Barwon-South Western Region is gratefully acknowledged. Support and evaluation: The research and evaluation team from Deakin University that contributed to the work in these reports consisted of Dr Colin Bell, Associate Professor Max de Courten, Dr Peter Kremer, Mary Malakellis, Louise Mathews, Dr Marj Moodie Dr Andrea Sanigorski, Annie Simmons, Professor Boyd Swinburn, with vital support from many research assistants including Leva Azadi, Anthony Bernardi, Lauren Carpenter, Kerri Cuttler, Phil Day, Caryn Kave, Lawrie Meade, Lily Meloni, Narelle Robertson and others. Students who have also contributed to the projects are gratefully acknowledged: Luke Atkin, Cheryl-Ann Bennett, Camilla Birkebaek, Floor de Groot. Abbey Harding, Diana Isgro, Melanie Nichols, Amelie Roullier, Deuwke Schokker, Moniek van Zutphen and many placement students.
4 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
Contents Acknowledgements
4
LISTOFFIGURES
9
LISTOFTABLES
10
ExecutiveSummary
12
Methods
12
KeyFindings
12
Conclusions
12
1.
BACKGROUND Childhoodobesity Dietandphysicalactivitypatterns Childhoodobesityprevention SentinelSiteforObesityPrevention,BarwonSWregion Thisreport
14 14 14 14 14 14
2.
OVERVIEWOFBEACTIVEEATWELLPROJECT
15
3.
FORMATIVEEVALUATION
16
Introduction
16
ProjectBrief
16
Approachtaken Acomprehensiveapproachtoobesityprevention Communitycapacitybuilding Lessonslearned–Projectbrief
17 17 17 17
Choiceoflocation
18
ProjectSetupandOrganisationalRelationships Lessonslearned–Approachtaken
18 18
DevelopmentofanActionPlan Lessonslearned–Projectsetup
20 20
TheActionPlan
22
5 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
Lessonslearned–TheANGELOProcess TheCommunicationPlan SocialMarketingPlan CommunicationPlan Lessonslearned–TheActionPlan 4.
PROCESSEVALUATION
22 25 25 26 26 27
Introduction
27
Evaluationcomponents(inputs) Evolutionoftheactionplan Records(minutes,reports) ProjectCoordinatordiaries Resourcesproduced,policytemplates,mediacoverageetc
27 27 28 28 28
Projectimplementation TVPowerdown Summaryofresults LessonsLearnedTVPowerdown BeActiveEatWellSchoolsInitiative Summaryofresults LessonsLearned–BAEWSchoolsInitiative BeActiveLunchpack Summaryofresults Lessonslearned–BeactiveLunchpacks AfterSchoolActivityProgram Summaryofresults BeActiveArts Lessonslearned–AfterSchoolActivityProgram Summaryofresults ActiveTransport Summaryofresults Lessonslearned–BeActiveArts ChoiceChips Summaryofresults Lessonslearned–Activetransport HappyHealthyFamilies Lessonslearned–ChoiceChips Summaryofresults Lessonslearned–HappyHealthyFamiliesprogram Lessonslearned–Overallprojectimplementation
28 28 29 29 30 30 30 31 31 31 32 32 32 32 33 33 33 33 34 34 34 35 35 36 36 36
6 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
5.
OVERVIEWOFIMPACTANDOUTCOMEEVALUATION
37
Design
37
Participants
39
Measures ThedetailsofallthetoolsareincludedinthereportonMethodsandTools. PrimaryOutcomeMeasures(OutcomeEvaluation) SecondaryOutcomeMeasures(ImpactEvaluation) EnvironmentMeasures DemographicMeasures Ethicsapproval
40 40 40 40 40 40 40
Statisticalanalysis
41
Commentsonevaluationdesign Whatworkedwell Evaluationdifficulties Lessonslearned–Evaluationdesignandmeasures
41 41 41 43
6.
FINDINGS
44
Anthropometry
44
Doingnoharm
45
Behaviouralchanges Nutrition Foodsanddrinksconsumedathome(parentreport) Lessonslearned–Outcomeevaluation Foodsanddrinksbroughttoschool(SchoolFoodChecklist) Lessonslearned–Eatingpatterns Physicallyactiveandsedentarybehaviours Lessonslearned–PhysicalActivitypatterns
45 45 45 45 46 48 49 49
EnvironmentalAudits Thenutritionenvironment Thephysicalactivityenvironment
50 50 51
CommunityCapacityBuilding CommunityCapacityIndex Lessonslearned–NutritionandPhysicalActivitySchoolEnvironment CommunityReadinesstoChange Lessonslearned–communitycapacity
52 52 52 55 57
7 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
7.
CONCLUSIONS
58
8.
PUBLICATIONS
59
9.
REFERENCES
61
APPENDICES
63
8 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
List of Figures Figure 1: LogicModelforBeActiveEatWellProject........................................................................15 Figure 2: TheANGELOprocess..........................................................................................................21 Figure 3: FlowdiagramofparticipationinBeActiveEatWellevaluation........................................38 Figure 4: AnthropometricoutcomesoftheBAEWintervention.......................................................44 Figure 5: Differencesinnumberofservesconsumedbychildrenatfollowupbetween Intervention(I)andComparison(C)group........................................................................46 Figure 6: AdjustedmeanchangeinbeverageservesinBeActiveEatWell......................................47 Figure 7: AdjustedmeanchangeinservesofkeyfoodsinBeActiveEatWell.................................48 Figure 8: Summaryof(adjusted)changeinoutsideplay,watchingTVandplayingelectronic gamesforinterventionandcomparisonsamples..............................................................49 Figure 9: AchievedcapacityforthedomainofNetworkPartnershipsatbaselineandfollowup....53 Figure 10:AchievedcapacityforthedomainofKnowledgeTransferatbaselineandfollowup......53 Figure 11:AchievedcapacityforthedomainofProblemSolvingatbaselineandfollowup............54 Figure 12:AchievedcapacityforthedomainofInfrastructureatbaselineandfollowup................54
9 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
List of Tables
Table1InitialactionplanforBeActiveEatWellproject.....................................................................23 Table2Characteristicsofthestudypopulationsatbaselineandfollowup.......................................39
10 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
List of Appendices AppendixA:
BAEWProjectBrief.....................................................................................................63
AppendixB:
TermsofReference....................................................................................................64
AppendixC:
TheANGELOProcess..................................................................................................67
AppendixD:
ActionPlanBeActive,EatWell.................................................................................69
AppendixE:
CommunicationPlan..................................................................................................87
AppendixF:
ResultsfromtheSchoolEnvironmentalAudit.........................................................107
AppendixG:
BAEWCommunityCapacity.....................................................................................113
AppendixH:
CommunityReadinesstoChange............................................................................117
11 WHO Collaborating Centre for Obesity Prevention, Deakin University Report 6: Lessons learned from Colac’s Be Active Eat Well project
Executive Summary Introduction Whole-of-community intervention programs are an important strategy to reduce childhood obesity. This report covers the first such demonstration project in Australia which was conducted (2003-2006) in the rural Victorian town of Colac (pop 11,000). The Be Active Eat Well (BAEW) project aimed to increase the community’s capacity to promote healthy eating and physical activity and prevent unhealthy weight gain in children aged 4-12 years.
Methods BAEW had a quasi-experimental, longitudinal design with anthropometric data collected on Colac children in 4 preschools and 6 primary schools at baseline (2003, n=1001, response rate: 58.0%) and follow-up (2006, n= 844, follow-up rate: 84.0%). The comparison sample was a stratified random selection of preschools (n=4) and primary schools (n=12) from the rest of the Barwon South Western region of Victoria, with baseline assessment in 2004 (n=1183, response rate: 44.0%) and follow-up in 2006 (n=983, follow-up rate: 83%). Other data collection involved a computer assisted telephone interview of parents, a grade 5 and 6 survey, a lunchbox checklist survey, an environmental school audit, and an assessment of capacity building using the Community Capacity Index.
Key Findings Colac children had significantly (p