Journal Watch

By Laura Guerra

We all know the numbers. Over the last 30 years, childhood obesity has more than doubled (from 7% to 18%), and adolescent obesity has more than tripled (from 5% to 18%). It has spread rapidly across race, gender, and class lines, and has disproportionately affected African-American, Mexican-American, and Native-American children. As nutritionists, we know a number of individual health behaviors and environmental factors play a role in the obesity epidemic. No one cause can be singled out because the multiple environments in which children are embedded (family, peer, school and society) operate together to influence the development of their health behaviors and health status.

Making behavior changes is difficult to begin with, and it can be especially hard for children and adolescents to follow through on good intentions when getting exercise is not easy or safe, or the only food options available are not healthy. Each of us has probably wondered what would it take to align a community to be more supportive? Would such an undertaking even be possible in a large city?

A study in Preventive Medicine looked at this type of community effort in Omaha, Nebraska, and the initial results were encouraging. The primary goal of the Omaha collaborative was to create community support for children achieving and maintaining a healthy weight. Activate Omaha Kids was designed, implemented, and evaluated using the Ecological Model, the Health Policy Model, and the Robert Wood Johnson Foundation Active Living by Design 5P Model.

These three models were used extensively throughout the organizational development and planning processes for this effort. The Ecological Model ensured all levels of the community were involved in the effort, and defined the scope of work needed to create meaningful results. The Health Policy model assured that community knowledge, political will, and social strategies were considered throughout the planning process. In the early phases of the program, it generated criteria to evaluate initial participants’ ability to be impactful, and later in the program generated the criteria to help rank the activities identified by the planning “plank” committees. And finally the Robert Wood Johnson Foundation 5P Model was expanded beyond its traditional scope of looking just at how the physical environment supports changes in physical activity, to look at how the nutritional environment supports healthy eating.

Having a single concise model enabled the collaborative to communicate its needs clearly.  The specificity of the final business plan produced by the collaborative allowed potential funders to see how each activity fit into the overall community plan, and delivered against the plan’s objectives. Funding requests were developed for 7 of the 24 initiatives and more than a million dollars were secured.

The community collaborative created by the partnership between Our Healthy Community Partnership and Alegent Health, Activate Omaha Kids, was quickly and successfully formed in part because it was designed, implemented and evaluated using the three models (Ecological Model, Health Policy Model, and the RWJF 5P Model). The models guided the process of building the overall plan by providing a framework to ensure that all levels of the community were represented, and that the ideas generated were comprehensive, specific, and feasible.

The study suggests it is possible to have a more cohesive collaborative structure by integrating models throughout the process, from selection of the participants through initiative selection and prioritization. Environmental change was possible because the effort involved all levels of the community actively from project onset: from identifying the issues, to planning how they might be addressed. In addition, the models provided an objective lens through which disparate groups could view the connectedness of their efforts. By using a theory or conceptual framework, the decision-making and project prioritization became a coordinated effort to fulfill the overall vision, rather than devolving into the individual agendas of the program’s significant number of participants.

References

Huberty, J.L., Balluff, M., O’Dell, M., Peterson, K., (2010). From good ideas to action: A model-driven community collaborative to prevent childhood obesity. Preventive Medicine, 50, S36 – S43.

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