Prevention of Childhood Obesity in the Borough of Hackney - Report Example

SCHOOL OF REHABILITATION SCIENCES BSc (HONS) PHYSIOTHERAPY Interprofessional debate Management Module PT3010 A proposal for the Prevention of Childhood Obesity in the Borough of Hackney Candidate number: Submission Date: Word Count: A proposal for the Prevention of Childhood Obesity in the Borough of Hackney Contents 1. Executive Summary……………………………………………………………… 3 2. Rationale for the suggested change …………………………………….………… 3 3. Critical Discussion……………………………………………………………….. 5 3.1 Devising the change management team………………………………………….. 6 3.2 Lewin’s Change Management Model………………………………………………7 3.3 Application of Unfreeze-Change-Refreeze………………………………………….. 8 3.3.1 Unfreeze…………………………………………………………………………… 9 3.3.2 Change (Moving Stage)……………………………………………………………. 9 3.3.3 Refreeze……………………………………………………………………………. 10 4. Conclusion and Recommendations…………………………………………………….. 11 5. References………………………………………………………………………………. 12 Appendix 1. Unfreeze-Change-Refreeze……………………………………………………..15 1. Executive Summary 1.1. This report is a result of a research into the childhood obesity percentage in the Borough of Hackney 1.2. The report suggests the introduction of preventive measures and a multidisciplinary approach in responding to the problem of childhood obesity in Borough of Hackney 1.3. The introduction of the change will be done in light of government policies and the transfer of public health from NHS to the local government. 1.4. The implementation of the change process will be based on Unfreeze-Change-Refreeze model supported with process flow and influence diagrams. 1.5. The report proposes The use of a team to spearhead the change Developing preventive measures to childhood obesity and, Piloting of the new change process in one school and five homes 2. Rationale Addressing childhood obesity is among the top priorities in public health today. In the Borough of Hackney, childhood obesity is an issue that must be quickly addressed because about a third of 10-11 year olds and more than a fifth of 4-5 year olds are either overweight or obese (Mohammed, 2013). The World Health Organization (2012) considers childhood obesity to be one of the topmost serious public health issues facing the society today (World Health Organization, 2012). If the problem is not solved, overweight and obese children are likely to increase the chance secondary health conditions and shorten their life expectancy (Mohammed, 2013). The review of the child obesity and overweight problems has been done at a time where public health responsibility is being moved from NHS to local government (Children and Young People Scrutiny Commission, 2013). This means that there is an issue of change management where the council has the opportunity to analyze and re-evaluate the manner in which the health of the community is championed and addressed (Local Development Framework, 2012). In the Borough of Hackney, more than a quarter of the population is under 20 years of age and the population is diverse. About 85 percent of the school children are from a black or minority ethnic group and a further 53 percent of the children are living in poverty. In the borough, children have higher than average levels of obesity. 24 percent of children who are 6 years of age and 14 percent of children in the reception year are at risk of obesity (Hackney, 2013; London health Observatory, 2010). It is also important to note that the number of children who participate in at least two or more hours in sport per week is less than average (Taylor, et.al 2005). The borough has a growing problem of childhood obesity and has second highest number of 6-year old children who are obese in the country. Two years ago, the Department of Communities and Local Government ranked the borough second in terms of the most deprived borough in the country in terms of the Index of Multiple Deprivation (IMD) (Children and Young People Scrutiny Commission, 2013). In England, most schools do not promote physical activities in addition to the fact that some schools do not include physical activity as part of their curriculum. In addition, these schools do not put much importance on healthy eating and body image among children (Trudeau & Shephard, 2005). One of the interventions for this change plan is to ensure that school curriculum will include healthy eating, emphasis on good body image and physical activity (Waters, et.al 2010). This intervention will not be enough on its own and will require additional measures, which will include increasing the sessions of physical activity and development of movement skills when children are in school. This is where physiotherapists will come in (Davis, et.al, 2007). The intervention will also emphasize on improvements in nutritional quality of diet in schools and will need the contribution of nutritionists. This will ensure that children eat foods that do not increase their chances of becoming overweight. Therefore, food supply in schools will reflect the change in nutritional quality of foods (Waters, et.al 2010). Another intervention would be establishing environments and culture that will support healthier foods and physical activity for children at home. Part of these will be the establishment of parent and guardian support and activities that will help children eat healthy, nutritious foods and spend most of their time in physical activity(Davis, et.al, 2007; Waters, et.al 2010). The above intervention means that there must be a team of physiotherapists, teachers, nutritionists and parent representatives who will lead the process of change. 3. Critical Discussion Research has indicated that obese or overweight children are at risk of developing secondary health related issues. For instance, Lobstein, Baur, Uauy and the IASO International Obesity Task Force (2004) indicated that such children are likely to experience health issues such as asthma, type II diabetes, sleep apnea, fatty liver disease and delayed or early puberty among others. These health issues can start when they are young and extend into adulthood (Lobstein, Baur, Uauy & the IASO International Obesity Task Force, 20004). Tremblay, Inman and Willms (2000) who acknowledge that overweight and obese children suffer from low self-esteem that causes low academic achievement support this research (Tremblay, Inman & Willms, 2000). A research by Davis, et.al (2007) reveals that unhealthy eating habits such as breakfast skipping, excessive energy and dietary fat intake, intake of sugar-sweetened beverages and foods, and eating large portions among others increase the chances of children becoming overweight and finally obese (Davis, et.al, 2007). Waters, et.al (2011) acknowledges that successful preventive interventions for childhood obesity feature issues that include educational, behavioral and health promotion interventions (Waters, et.al, 2011). Flynn, et.al (2006) supports these interventions in the conclusion that modification of nutrition and physical activity environments show a promising change despite the fact that they have not bee applied with adequate vigor (Flynn, et.al 2006). These have already been highlighted in the rationale section. In this change plan, the terms measures and interventions will be used interchangeably. To support the effectiveness of the prevention of childhood obesity in the Borough of Hackney and ensure its efficient functioning, the implementation of the preventive measures will be based Kurt Lewin’s model of unfreeze-change-refreeze (Wirth, 2004; Kritsonis, 2005). This model has three stages in that the unfreeze stage is the current state, the change stage is the transition state and the refreeze stage is the future or desired state. The process will be planned in a detailed manner and managed by a team of selected to spearhead and sell the change to schools and homes. Challenges such as lack of cooperation among schools and staff, fear and resistance of change are expected in this change plan (Spetz, Burgess & Phibbs, 2012). These are some of the issues that will be addressed by the team 3.1. Devising the change management team Devising a change management team will be important for the plan to work because an effectiveness cannot be achieved when stakeholders are left out in finding the appropriate measures for prevention of childhood obesity and implementing them. Therefore, a change management team will be established from various sectors to represent different interests and views in to the change plan (Rew, 2010). The team desired in the change plan will include professionals from public health institutions, the community likely to be affected (borough of Hackney), parents and families, schools, partners, the children and representatives of the local government because they play a part in public health policy formulation and implementation. Physiotherapists, social workers, dieticians and nutritionists will be included in the change process to ensure that the change is inclusive of hospital and community care (The Chartered Society of Physiotherapy and The Stroke Association, 2010) The different members of the team have important roles to play in the identification and implementation of preventive measures against obesity in children. For example, physiotherapists will be important in identifying and improving the movements and functioning of children physically in terms of play especially for overweight and obese children (The Chartered Society of Physiotherapy and The Stroke Association (2010). 3.2. Lewin’s Change Management Model The model of change will be Lewin’s Unfreeze-change-Refreeze (Ajzen, 1985).The importance of this model is that it focuses on the change from the inception, development up to the end of the change where it has been normalized as an everyday behavior in the society (Schein, 1996). The model is practical in its application. For the process to be successful, all three steps must be followed respectively in that people should unfreeze the present, initiate change, implement the change to future practice and put in place the required resources including personnel to ensure that the change is permanent (Lewin, 1951). Another advantage with this model is that it is meant for planned change as opposed to acting as a response to unplanned change (Lewin, 1951). This model will fit into the implementation of preventive measures for childhood obesity desired in this paper. However, the change model can respond to any unplanned changes within the plan because the refreeze stage ensures that all challenges or unexpected turn of events is solved. Another advantage is that the model encourages the team to sell the change to the society, emphasise the benefits of the change and identify potential problems to respond to (Schein, 1996). The application of the model will start by understanding the three stages in Unfreeze-change-Refreeze. In Lewin’s unfreezing stage, the team must identify and solve issues related to the problem and develop strategies to strengthen the change and weaken the challenges (Bozak, 2003). The stage also involves the identification of key players likely to be affected by the change and communicate to them the reasons and benefits of the change (Bozak, 2003). The second stage, which is the moving stage, involves the stage where the change takes center stage. These is where the opposing views identified in unfreezing stage have been solved and made it possible for the change to occur. The change is implemented such that the desired objectives are met. Communication is important in this stage (Ajzen, 1985). The refreezing stage is where the stability of the change is evaluated including its overall effectiveness within practice. If there are any issues, this stage ensures that they are solved to ensure the effectiveness of the change (Bozak, 2003). It is proposed that the change intended in this paper will be piloted in one school and 5 homes to evaluate its effectiveness before wide implementation. 3.3. Application of Unfreeze-Change-Refreeze The most important part is to implement or test the proposed change. 3.3.1. Unfreeze In this stage, the team will determine the change, which will be a focus on preventive measures on childhood obesity in Borough of Hackney. For example, physiotherapists will have to study the amount of time taken by children to engage in physical activity and use the information to formulate the best change initiative that discourages childhood obesity (Schein, 1995). The most important aspect here is to communicate with all stakeholders including, school administrators, teachers, physiotherapist, nutritionists and parents. Here communication must be open and honest to ensure trust develops among all those involved in the proposed change (Bozak, 2003). Including these stakeholders, especially teachers and parents will ensure that they develop a sense of inclusion that will overcome possible resistance and enable them understand the benefits of change to children (Waters, e.al, 2010). Here, round table discussions will be important in identifying challenges and restraining forces that should be overcome. These restraining forces may include lack of cooperation fear and resistance to change among teachers and parents. Challenges may include lack of finance and lack of support from school administration boards and public health administration. The important aspect is to engage the team to iron out these issues (Bozak, 2003). 3.3.2. Change (Moving stage) This is the actual change stage, which includes planning and implementation. Implementing the preventive interventions will include the implementation of school curriculum that include healthy eating, emphasis on good body image and physical activity and increase of the sessions of physical activity. Other aspects will include development of movement skills when children are in school, improvements in nutritional quality of diet in schools, establishing environments and culture that will support healthier foods and physical activity for children at home and ensuring support systems for parents (Davis, et.al, 2007). The team must communicate effectively because the change involves different people meaning that updates must be communicated. This will require a hands-on management approach to help people see the actual benefits (Burnes, 2004). Time is also an important factor. At this stage, the team must give people the time to connect with the change. It must be a smooth process that moves gradually (Wirth, 2004). 3.3.3. Refreeze This stage comes when people are used to the changes introduced and see it as a usual phenomenon. When the changes are taking shape and people have embraced the change, then the team will be ready to refreeze (Schein, 1995). The outward signs of refreeze will be a society where parents engage the healthcare practitioners to get advice on preventing childhood obesity; children eat healthy foods, engage in physical activity and other activities that focus on preventing childhood obesity. The unfreeze stage should also allow people to internalize and institutionalize the change (Ajzen, 1985). For example, teachers and parents will need support to ensure that they prevent childhood obesity. This may include funding, empowerment and also government help to achieve the desired change (Kritsonis, 2005). In this stage, support and training must be offered for people to understand the importance of preventing childhood obesity and adopt it in their culture. The team to guide the process will provide leadership. At this stage also, barriers to preventing childhood obesity will be identified and plans formulated to counter issues such as refusal or lack of funds to change diet, lack of enough time for physical activity and lack of parental support among others (Kritsonis, 2005). 4. Conclusion and Recommendations In the Borough of Hackney, childhood obesity is an issue that must be quickly addressed because about a third of 10-11 year olds and more than a fifth of 4-5 year olds are either overweight or obese. Twenty-four percent of children aged 6 years and 14 percent of children in reception year are at risk of obesity (Hackney, 2013; London health Observatory, 2010). It is also important to note that the number of children who participate in at least two or more hours in sport per week is less than average (Hackney, 2013). The introduction of preventive measures to childhood obesity is meant to remedy the above situation to improve the health of the children and help in reducing chances of adult obesity and the resources used to treat it. The percentages represent figures that could go up if preventive measures, such as change in diet, increase in physical activity and formulation of safe food policies among others are not implemented. If let to progress, the Borough in Hackney will be a troubled society, which will also affect other parts of the country including its economy. To facilitate the change process physiotherapists, community health workers, social workers, parents, general practitioners, children and guardians among others will be established to enable the change process. It is recommended that the change will be supported by Lewin’s model of change with Unfreeze-Change-Refreeze. It is proposed that a pilot of the change will be done in one of the schools at Borough of Hackney and 5 homes in the area for a period of one month to assess the effectiveness of the change before it can be rolled out further. 5. References Bozak, M., (2003). Using Lewin’s force field analysis in implementing a nursing information system. Computers, Informatics, Nursing, 21(2), pp.80-85. Children and Young People Scrutiny Commission (2013). Report Of The Children and Young People Scrutiny Commission http://www.hackney.gov.uk/childhood-obesity.htm Davis, M. M., Gance-Cleveland, B., Hassink, S., Johnson, R., Paradis, G., & Resnicow, K. (2007). Recommendations for prevention of childhood obesity. Pediatrics, 120(Supplement 4), S229-S253. Flynn M, McNeil DA, Maloff B, Wu M, Ford, C & Tough SC (2006). Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obesity Reviews, 7(Suppl. 1), 7-66. Garbarino, S., & Holland, J. (2009). Quantitative and qualitative methods in impact evaluation and measuring results. Hackney (2013). Childhood obesity scrutiny review. Retrieved from http://www.hackney.gov.uk/childhood-obesity.htm#.U02fiKOxTIU Jun, G. T., Ward, J., Morris, Z., & Clarkson, J. (2009). Health care process modelling: which method when?. International Journal for Quality in Health Care, 21(3), 214-224. Kritsonis, A. (2005). Comparison of change theories. International journal of scholarly academic intellectual diversity, 8(1), 1-7. Lake, A. M. (2012). Pediatric Obesity Preventive Measures in Early Childhood. Journal of Parenteral and Enteral Nutrition, 36(1 suppl), 76S-80S. Langley, G.,J., Moen, R.,D., Nolan, K.,N., Nolan, T.,W., Norman, C.,L., Provost, L.,P., (2009) The improvement Guide A Practical approach to Enchancing Organizational Performance 2nd edn. San Francisco: Jossey-Brass. Lobstein T, Baur L, Uauy R, the IASO International Obesity Task Force (2004). Obesity in children and young people: a crisis in public health. Obes Rev; 5 (Suppl 1):4-85. Local Development Framework (2012). Development Management Local Plan Draft for Public Participation’ LB Hackney. (p.22) London health Observatory (2010). HACKNEY Child Health Profile. Retrieved from http://www.lho.org.uk/Download/Public/16212/1/CHP_Hackney.pdf Mohammed, S. (2013). Hackney kids face growing obesity problem. Retrieved from http://www.hackneygazette.co.uk/news/hackney_kids_face_growing_obesity_problem_1_1868189 Schein, E. H. (1995). THEORY:" LEWINS CHANGE MODEL ELABORATED. Invited paper for a special issue of Systems Practice edited by Susan Wheelan. Schein, E. H. (1996). Kurt Lewins change theory in the field and in the classroom: notes toward a model of managed learning. Systems Practice, 9(1), 27-47. Spetz, J., Burgess, J. F., & Phibbs, C. S. (2012). What determines successful implementation of inpatient information technology systems? The American Journal of Managed Care, 18(3), 157-162. Taylor, S. J., Viner, R., Booy, R., Head, J., Tate, H., Brentnall, S. L., ... & Stansfeld, S. (2005). Ethnicity, socio-economic status, overweight and underweight in East London adolescents. Ethnicity & health, 10(2), 113-128. The Chartered Society of Physiotherapy and The Stroke Association (2010) Moving on. A vision for community based physiotherapy after stroke in England. London: The Stroke Association. Tremblay MS, Inman JW, Willms JD (2000). Relationships between physical activity, self-esteem, and academic achievement in ten- and eleven-year-old children. Pediatr Exer Sci 11(3):312-23. Trudeau, F., & Shephard, R. J. (2005). Contribution of school programmes to physical activity levels and attitudes in children and adults. Sports Medicine, 35(2), 89-105. Waters E, et.al, (2011). Interventions for preventing obesity in children (Review). Cochrane review, 12. World Health Organization. (2012). Population-based approaches to childhood obesity prevention. Wirth, R. A. (2004). Lewin/Schein’s change theory. Retrieved November 28, 2008. Appendix 1 Practical Steps for Using the Framework: Unfreeze 1. Determine what needs to change. Survey the organization to understand the current state. Understand why change has to take place. 2. Ensure there is strong support from upper management. Use Stakeholder Analysis and Stakeholder Management to identify and win the support of key people within the organization. Frame the issue as one of organization-wide importance. 3. Create the need for change. Create a compelling message as to why change has to occur. Use your vision and strategy as supporting evidence. Communicate the vision in terms of the change required. Emphasize the "why". 4. Manage and understand the doubts and concerns. Remain open to employee concerns and address in terms of the need to change. Change 1. Communicate often. Do so throughout the planning and implementation of the changes. Describe the benefits. Explain exactly the how the changes will effect everyone. Prepare everyone for what is coming. 2. Dispel rumors. Answer questions openly and honestly. Deal with problems immediately. Relate the need for change back to operational necessities. 3. Empower action. Provide lots of opportunity for employee involvement. Have line managers provide day-to-day direction. 4. Involve people in the process. Generate short-term wins to reinforce the change. Negotiate with external stakeholders as necessary (such as employee organizations). Refreeze 1. Anchor the changes into the culture. Identity what supports the change. Identify barriers to sustaining change. 2. Develop ways to sustain the change. Ensure leadership support. Create a reward system. Establish feedback systems. Adapt the organizational structure as necessary. 3. Provide support and training. Keep everyone informed and supported. 4. 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