Program Proposal and Evaluation for Prevention of Childhood Obesity in Salisbury - Term Paper Example

PROGRAM PROPOSAL & EVALUATION FOR PREVENTION OF CHILDHOOD OBESITY IN SALISBURY Student’s Name Professor Course Date 1. Title & Description In South Australia, childhood obesity is a major and growing public health concern, which has reached epidemic levels (Government of South Australia 2006). The aim of this project is to create an intervention in the local government area of Salisbury involving parents and schools to promote healthy eating habits among children and to encourage children to be physically active. This program will be committed to reducing childhood obesity through promoting healthy eating habit and calling for children to be physically active. The partners and stakeholder who will contribute and take part in this intervention are parents, the city council of Salisbury and the stakeholders in the OPAL health weight program. The program will serve as an action plan to inspire parents, the community, institutions, and agencies to recognize the importance of feeding children healthy foods and encouraging them to be physically active. It will also raise awareness about childhood obesity, offer resources for supporting families and practitioners, build momentum, and support for the organizations, which are already addressing this issue. Working collaboratively with these groups will enable leveraging of resources and instituting promising practices for ensuring a health future for the City of Salisbury children. 2. Evidence of Need Increasing Childhood Obesity Cases The prevalence of childhood obesity in the local government of Salisbury has been rising steadily. One quarter of children in South Australia are obese and there are indicators that this number is still increasing yearly by 1%, which suggests that half of all young Australian will be obese by 2025 (Government of South Australia 2006). According to Salisbury City Plan 2020, the impact of obesity amongst the residents, especially children is of serious concern to the community. The childhood obesity issue should thus be prioritized as a public health concern. The city plan also recognizes that for the community to change their attitude and levels towards obesity there is need to embrace specific programs that will have a demonstrable positive impact. The Salisbury community development strategy (2008) proposed the need to ensure that financially disadvantaged persons have the chance of learning about and accessing healthy foods and healthy behaviors, for instance, exercise. As a result, this program would come in handy for the City of Salisbury to ensure that the childhood obesity issue is tackled. There is the opportunity to offer learning opportunities on healthy diets to the children and families through community centers, schools, recreation center, community centers, and other community facilities. The success of this program can be replicated in whole of South Australia. Health problems resulting from obesity Overweight children are exposed to very serious health problems as children and in the future as adults, as the overweight children are prone to be overweight adults and hence more likely to suffer from diabetes, cardiovascular diseases, hypertension and cancer in adulthood. These chronic diseases are mostly preventable and they account for numerous deaths in South Australia. These and other conditions related to physical inactivity and overweight places a burden on the State economy with very high and avoidable long-term costs. Cause of increased obesity cases The Department of Health (2006) proposed that being overweight or obese is caused by ‘under-activity’ and ‘over-eating in other words, where the energy used is less than that consumed. This point to the fact that encouraging children to consume a healthy diet and to be physically active will help them generates superior control over this issue. These two aspects bring about preservation of a healthy weight, which is critical for healthy growth as well as development both for children and throughout life. As the percentage of overweight and physically inactive children rises and as the children get older, the health problems that they will experience will give rise to increased medical care costs, reduced or lost human resources and productivity. Obesity Prevention programs inadequacy There are programs that have been put in place for preventing and reducing childhood obesity such as OPAL, however more work needs to be done as the number of overweight children is still rising. Taking further action by instituting this program will have profound impacts on increasing the quality of life for children in the City of Salisbury. With its exceptional climate as well as many outdoor recreation opportunities, the City of Salisbury offers a favourable environment for children leading a healthy life. High Physical in activity levels among children Physical inactivity levels also play a significant role in development of childhood obesity. There is a connection between inactivity and health risk among children and adults in Australia and this highlights the significance of physical activity as a public health priority for disease prevention and health promotion (Drummond, Drummond & Dollman et al. 2010). Shi, Taylor & Gill (2010) also found that low levels of physical activity add an additional risk to short sleep duration. Most of the children lead sedentary lifestyles. A Federal Australian government report (Australian Institute of Health and Welfare (AIHW), 2006, argued that the imbalance between the intake of calories and energy expenditure derived from physical activity is a major aspect impacting the global obesity epidemic. Participation in physical activity is a critical factor associated with obesity and chronic diseases in South Australia (Population Research and Outcome Studies, 2012) Rationale By using these interventions, the program is aiming to create a supportive environment that encourages and supports healthy behaviours’ in order to promote healthy weight in children. Supportive environment will create and support the changes in health behaviours through reorganization of the eating habits and physical exercises. A supportive environment will encourage parents and schools to take part in planning and implementing the program. Battle (2009) argues that families, health providers, schools and other community groups should be involved to encourage children to adopt behaviours, which promote better health. Jelalian and Steele (2008) propose that shared public health action focuses on promoting healthy behaviours such as health eating and active lifestyles, which check the onset of overweight among children. The two further argued that to promote health-promoting environments, numerous changes should be instituted in the settings where the children reside, learn and play- in their schools, homes, neighbourhoods, faith organizations and youth organizations. This can optimize the environment for preventing obesity among children according to the two authors. Policies that the program is aligned with OPAL promotes health-promoting environment for children by supporting them through their families and communities-the program promotes creation of opportunities for eating well and being activities through the communities in South Australia. All people in the community work together to create all kinds of manners for enjoying healthy eating and to have fun being active. The South Australian Eat Well Be Active Strategy 2011–2016 proposes that there should be an increase in the daily serving of vegetables and fruits taken by at least 0.2 for fruits and 0.5 for vegetables from baseline for each state by 2013, and by 0.6 for fruits and 1.5 for vegetables by 2015 The OPAL program is founded on the French Program EPODE, which discovered that involving the entire community (families, schools, local governments, shop owners, cultural associations and the local government) is effective in preventing childhood obesity (SA Strategic Plan n.d.). In “South Western Region of Victoria,” the demonstration program built on community based interventions and action research is “Sentinel Site for Obesity Prevention”; this program builds the skills, evidence, and programs necessary for attenuating and eventually reversing obesity epidemic in children (Bell, Simmons & Sanigorski et al. 2008). Sluijs, Kriemler and McMinn (2011) study show that family and community interventions on children physical activity levels are very effective compared to the other programs. The Be Active Eat Well study in Australia also focussed on society capacity building as well as action planning in order to maintain healthy lifestyles among children (Swinburn 2009; Sanigorski, Bell & Kremer et al. 2008). The “Ottawa Charter for Health Promotion advocates for development of individual knowledge and skills, strengthening community action, creating supportive environments, developing healthy public policy development and reorienting services to health” (Public Health Agency of Canada 2012). This program is aligned with these policies and program because it focuses on development of parents and children knowledge and skills, strengthening community action in response to the overweight problems and creating supportive environments for reducing the number of children with overweight problems. It is in line with principles of primary health care as it addresses the social determinants of health, involves community in decision making, builds capacity for self reliance, promotes health and prevents illness, uses socially and culturally appropriate methods, facilitates inter-sectoral collaboration and undertakes advocacy and political action (Talbot & Verrinder, 2010) The social learning theory and Community mobilization: Rothman’s Framework are aligned with this program. Social learning theory identifies the significance of social cues and norms, self efficacy/confidence and environmental influences on health behaviour. Health promoters according to this theory act as agents of change and facilitate change through modifying the social environment and the development of capacities and skills that enable people to make healthy choices. According to this framework, the active involvement of community members in identification of health priorities and developing fitting actions to deal with the priorities is a fundamental aspect of health promotion practice. 3. Program Plan Overall Objective The program will be in line with the recommended strategies by the Ottawa Charter for health promotion (1986), which include: Development of individual skills and knowledge Creating supportive environments Strengthening community action Development of healthy public policy development Reorienting services to health Strategies Health Problem: Increased number of obese or overweight children Overall Goal: The overall goal of this program is to provide an evidence-based diet and lifestyle intervention program for children living in the City of Salisbury, who have or at risk of developing obesity and to mobilize the community in order to take action regarding the promotion of healthy dietary habits and active lives amongst children and recognizing their achievements. The program seeks to reduce childhood obesity by promoting changes in Salisbury Determinants: Impact Evaluation (Focus Group discussions, Questionnaires) Process Evaluation (Focus Group discussions, Questionnaires) Objectives: In line with evidenced based best practices for children eating habits intervention to prevent or hinder the development of diseases such as diabetes, cardiovascular diseases, hypertension, which come about from one being overweight or obese, and consistent with OPAL recommendations for achieving a healthy lifestyle (OPAL 2012), the objectives of this program are: 100% of the participants will report children are consuming healthy foods regardless of where their parents/guardians work, live, worship, play or go to school. Children will consume an array of healthy food-consume a lot of legumes, vegetables, cereals, and fruits and eat only restrained amounts of sugars as well as foods with added sugars and foods with low saturated fat, as recommended by the “Australian Government, National Health & Medical Research Council and Department of Health and Ageing”, 2012 feeding guidelines. Increased opportunities for all children to access and consume healthy diets in the appropriate manner 100% of the participants will report increased opportunities for all children and their families to engage in physical activities-Ideally will achieve and maintain for not less than 30 minutes per day of reasonable to enthusiastic physical activities. The physical activity guidelines for Australians advocate that children and teenagers should put at least 30 minutes of restrained intensity physical activities preferably every day. 100% of the participants will report increased awareness of the problem of childhood obesity in the community as well as increased community support in reduction of childhood obesity cases Strategies: 1. The first strategy will entails mobilizing the parents, school heads and teachers in order to educate them on the importance of healthy dietary habits and active lives amongst children. The Council will play an important role in mobilizing these members. The council will help in convening these groups to attend free education program targeting parents and school heads living in the City of Salisbury. The education will be delivered in all the rural localities and suburbs in the City of Salisbury. In addition, the program will also offer free obesity screening for the children- a routine track of the children body mass index (BMI). The parents will be offered relevant evidence based counselling on dietary habits and physical exercises importance. The providers will be knowledgeable about the children languages, cultures, and traditions. There will be a multidisciplinary, family cantered curriculum based on best practices for teaching families and children about obesity prevention and treatment. Culturally appropriate health education lectures on nutrition, exercise, food shopping, cooking, meal planning and other areas will be part of the program, and they will increase the parents and schools knowledge and skills so that they can make healthy changes. 2. The strategy will entail ensuring that the places where the children live, learn, play, and eat make it easy for them to eat a healthy diet and be active. The important stakeholders in this action area will be parents and schools, as children spend most of their time either with their parents or in school. Both parents and schools will be engaged to advance the following strategies for preventing childhood obesity: Providing children with health education which address physical activity, nutrition as well as adoption of other obesity preventive lifestyle choices Integration of obesity prevention content into the main education curriculum Expansion of physical activities opportunities Adoption of healthy dietary standards for cafeteria as well as other food outlets Promotion of improved affordability or access to fresh vegetables and fruits in all schools 3. The third strategy will entails engaging the council in implementation of policies that improve the social, constructed, and natural environment, and support the children to consume healthy foods and to be physically active. It is hard for children to make healthy choices when there are barriers such as vending machines in schools stocked with chocolate bars and sugary drinks. There will be need to create an environment that encourages and supports healthy behaviours in order for the intervention to be successful. Changes in policy should be integrated into children’s normal environment and activities. A BMI test will be completed for all the participants before enrolment into the program and after a six months period to assist in the potential identification of the effectiveness of the strategies employed and groups most at risk of developing obesity. A child will be considered to be overweight if his or her BMI will be between the 84th percentile and the 94th percentile on the standard growth chart whereas an obese child will be above the 95th percentile. This will be in line with the ‘BMI for age’ percentile ranges that the “Center for Disease Control (CDC)” in the US developed (Barlow & the Expert Committee 2007). ‘ 4. Community Engagement, Stakeholder Engagement, and Capacity Building The intervention will engage the stakeholders and community through a number of initiatives: The Council will be engaged to put into practice healthy food practices in schools, for instance, by banning junk food in canteens and cafeterias; this is one of the best mechanisms for creating a healthier environment and achieving extensive changes in unhealthy eating habits among children. The council will thus be engaged to advance various strategies for preventing childhood obesity. Such strategies will include: Increasing the quality, quantity and accessibility to natural open spaces and parks to encourage physical activity among children Ensuring that vending machines on all city owned space and facilities have healthy food choices and also encourage community partners to do the same Engaging community centres’ and recreational centres in delivering messages about feeding children healthy diets Parents will be engaged by being encouraged to take the lead in ensuring that they feed their children healthy foods and limit the children screen (computer and television) time to a maximum of two hours per day. The parents will be assisted to make use of innovative ways of promoting healthy nutrition and physical activities with the children. They will be encouraged to model behaviours which demonstrate healthy eating habits and physically active lifestyles for their children Community based organizations, faith congregations and youth organizations will be enlisted and empowered to reach parents and schools to increase awareness of healthy lifestyle and to organize physical activities. These organizations will also be asked to eliminate advertising as well as selling of foods and beverages that are not healthy to children and the community based, faith based and youth organizations. 5. Timeline & Resources Strategies Time (0-12mnths) Resources Strategy1: Mobilizing the City of Salisbury residents in different regions Conducting follow ups every 4 weeks 20 weeks Nutritionists Health care providers Money for moving from one locality to the next and hiring halls Strategy 2: Ensuring that the places where children live promote healthy eating habits and physical exercises 20 weeks Money for moving from one locality to the next Strategy 3: Engaging the council in implementation of policies that promote healthy lifestyles 8 weeks 6. Budget Category Proposed Amount Project Total Contracted health care providers such as nurses, nutritionists and doctors (6) 6 personnel @ $ 12,000 each $72,000 Supplies/Materials $10,000 $10,000 Communication Costs $15,000 $15,000 Occupancy Costs (utilities, rent) $30,000 $30,000 Capital Outlays $15,000 $15,000 Travel Expenses (Mileage, meals, hotels & transportation $20,000 $20,000 Total Direct Expenses $152,000 Program Plan Schema HEALTH PROBLEM Increased number of obese or overweight children GOAL To provide an evidence-based diet and lifestyle intervention program for children living in the City of Salisbury, who have or at risk of developing obesity OUTCOME EVALUATION Focus Group Discussions Questionnaires Participant Observation DETERMINANTS Impact and process evaluation OBJECTIVES 100% of the participants will report children are consuming healthy foods regardless of where their parents/guardians work, live, worship, play or go to school 100% of the participants will report increased opportunities for all children and their families to engage in physical activities-Ideally will achieve and maintain for not less than 30 minutes per day of reasonable to enthusiastic physical activities 100% of the participants will report increased awareness of the problem of childhood obesity in the community as well as increased community support in reduction of childhood obesity cases IMPACT EVALUATION Focus Group Discussions Questionnaires STRATEGIES Bringing the teachers and parents together in order to educate them on the importance of healthy dietary habits and active lives amongst children. Ensuring that the places where the children live, learn, play, and eat make it easy for them to eat a healthy diet and be active. Engaging the council in implementation of policies that improve the social, constructed, and natural environment, and support the children to consume healthy foods and to be physically active. PROCESS EVALUATION Focus Group Discussions Questionnaires Evaluation Plan Objectives Strategies Impact indicators Process Indicators Data Collection Methods & Tools 100% of the participants will report children are consuming healthy foods Developing residents skills and knowledge Strengthening community activities Creating supportive settings School programs which educate children on importance of healthy diets and physical exercise Reduced consumption of foods with saturated fats and those with high sugar content Reduced Numbers of children who are overweight Reduced complications arising from being overweight or obese Report by residents that the project has had a positive impact and they are more aware of importance of feeding children healthy foods Use of questionnaires and focus group discussions with the stakeholders 100% of the participants will report increased opportunities for all children and their families to engage in physical activities Promotion of policies and use of environments that support children to take part in physical activities Engaging parents to reduce their children screen time to take part in other recreational activities which reduce their BMI School programs which educate children on importance of healthy diets and physical exercise Increased physical activities among children at home and in the parks Reduced Numbers of children who are overweight Reduced complications arising from being overweight or obese Report by residents that the project has had a positive impact and children are physically active Participant Observation to observe whether children are active in home, schools and in the parks Use of questionnaires and focus group discussions with parents and teachers Engaging the council in implementation of policies that promote healthy eating & physical exercises Demonstrating to the council the impact of implementing such policies Reduced number of overweight or obese children Reports that the project has had a positive impact due to consumption of healthy foods and increased physical activity Use of questionnaires and focus group discussions to determine the impact of policy change This funding will be sourced from the government of South Australia, the City of Salisbury Council Evaluation Method One of the objectives of this program is that 100% of the participants will report increased opportunities for all children and their families to engage in physical activity. Realization of this projected will be brought about by promotion of policies and use of environment which support children to take part in physical activities, parents control of the children screen time and implementation of school programs that educate children on importance of physical exercises. Participant observation, questionnaires, and focus group discussions are the selected data collection methods and tools. Participant observation is important, as it will allow the evaluator to place himself in direct contact with the children as they go about their affairs (Weinberg 2002). A full participant observation in school might be impossible because of physical size and in this case, a semi participant observer such as a teacher will be chosen (James, Jenk & Prout 1998). Questionnaires will enable the evaluator to determine whether children take part in physical activities while at home or at schools from the responses given by the respondents. They are helpful in gathering data that is unique to individuals such as knowledge and attitudes. The limiting factor of questionnaires is that it will only provide quantitative data and not qualitative data (Babbie 2012). Qualitative data will be acquired from the focussed group discussions with the parents, teachers, and other stakeholders. Focussed group discussions will enable the evaluator to explore the way meanings and experiences about healthy eating habits and physical exercises are negotiated and contested between the participants (Stewart, Rook & Shamdasani 2007; Lunt & Livingston 1996). The evaluator will solicit information by discussing or talking. A purposive sample will be chosen comprising of teachers, parents, and organization leaders. These participants will answer the questions and take part in the focussed group discussions. The quantitative data from the questionnaires and qualitative data from the focused group discussions will be analyzed to determine the impact of the strategy. Evaluation Tool The research tool for the impact and process evaluation will be the questionnaire. The questionnaire will contain evaluation questions on the impact of the strategies of increasing opportunities for all children and their families to engage in physical activities. A pre-program measurement will offer a baseline against which the post program results will be compared. Impact Process Evaluation Questions 1. Are there more policies which encourage children to take part in physical activities 2. Are these policies effective 3. Are families and children increasing recreational facilities such as parks 4. Are parents increasingly engaging children to reduce screen time to take part in other recreational activities which reduce their BMI 5. Is the school playing an important role in education children on importance of healthy diets and physical exercise Does this education has any impact? Process Evaluation Questions 1. To what extent does the program provide model policies for supporting healthy dietary habits and active lifestyles among children? 2. How many schools and people in the City of Salisbury are aware of this program 3. How many people and schools are implementing the policies recommended by the program 4. How useful was our assistance in helping schools and parents implement and adopt behaviours that promote healthy eating habits and active lifestyles 5. How effective has the program been in preventing and reducing childhood obesity Reference List Australian Government, National Health & Medical Research Council & Department of Health and Ageing n.d Dietary guidelines for children and adolscents in Australia, viewed October 29, 2012, http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n30.pdf Barbie, E 2012, The Practice of Social Research, 13ed, Wadsworth Publishing, Belmont, CA. Barlow SE & the Expert Committee 2007, Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report, Pediatrics, vol. 120, pp. S164—S192. Battle, C 2009, Essentials of Public Health Biology: A Guide for the Study of Pathophysiology, Jones & Bartlett Publishers, Sadbury, MA. Bell, C., Simmons, A., Sanigorski, A., Kremer, P. & Swinburn, B 2008, Preventing childhood obesity: the sentinel site for obesity prevention in Victoria, Australia, Health Promot. Int. 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