USE OF GROUP MODEL BUILDING TO DEVELOP IMPLEMENTATION STRATEGIES FOR EARLY CHILDHOOD OBESITY PREVENTION Ariella Korn, MS, MPH New Balance Doctoral Fellow 9 th Annual Conference on the Science of Dissemination and Implementation in Health December 15, 2016
CO-AUTHORS Washington University University of Rhode Island Peter Hovmand, PhD Alison Tovar, PhD, MPH Nancy Zoellner, MPH Tufts University Brookings Institution Karen Fullerton, MEd, RD Ross Hammond, PhD Erin Hennessy, PhD, MPH Christina Economos, PhD
OVERVIEW 1. Background a. Obesity prevention in early childhood b. Group model building (GMB): what, why, and how 2. “Shape Up Under 5” case study 3. Benefits and challenges 4. Implications for D&I research
INTERVENING EARLY Birth – 5 years Establishing healthy behaviors healthy weight trajectories • Feeding/nutrition • Physical activity • Screen time • Sleep Gap : how can communities implement interventions within naturalistic settings, and with sufficient reach and scale to achieve population-level impact?
GROUP MODEL BUILDING (GMB) Participatory method grounded in system dynamics involving community stakeholders in the process of externalizing mental models and developing visual models to better understand complex systems Can facilitate design and adaptation of intervention strategies that take into account the inherent complexities of implementation Glasgow RE. 2008. What types of evidence are most needed to advance behavioral medicine. Annals of Behavioral Medicine 35: 19-25. Hovmand PS. 2014. Community based system dynamics . Springer, New York, NY. Powell BJ, RS Beidas, CC Lewis, GA Aarons, JC McMillen, EK Proctor, DS Mandell. 2015. Methods to improve the selection and tailoring of implementation strategies. Journal of Behavioral Health Services & Research : 1-17. Richardson GP. 2011. Reflections on the foundations of system dynamics. System Dynamics Review 27(3): 219-243. Vennix J. 1996. Group model building . John Wiley & Sons, New York.
GMB WITHIN A CBPR CONTEXT Collaboration and trust • Grounded in community expertise, experience, and Community Synergy: engagement language partnership + in research co-learning CBPR process • Identifies leverage points, + GMB barriers, and facilitators • Promotes shared understanding and empowerment • Bridges disparate priorities and Culturally- Partnership centered dynamics builds consensus interventions CBPR Conceptual Model, Adapted from Wallerstein et al., 2008 & Wallerstein and Duran, 2010 Glasgow RE. 2008. What types of evidence are most needed to advance behavioral medicine. Annals of Behavioral Medicine 35: 19-25. Hovmand PS. 2014. Community based system dynamics . Springer, New York, NY. Powell BJ, RS Beidas, CC Lewis, GA Aarons, JC McMillen, EK Proctor, DS Mandell. 2015. Methods to improve the selection and tailoring of implementation strategies. Journal of Behavioral Health Services & Research : 1-17. Vennix J. 1996. Group model building . John Wiley & Sons, New York.
GMB “HOW TO” Select activities/scripts that work toward addressing a common problem of interest Scriptapedia Sequence of activities and boundary objects Divergent versus convergent Adaptable to fit context Roles : room set-up, facilitator, meeting convener, modeler, reflector, debriefer, note takers, process coach What helps: expertise, practice, and creativity Hovmand PS. 2014. Community based system dynamics . Springer, New York, NY. Vennix J. 1996. Group model building . John Wiley & Sons, New York. https://en.wikibooks.org/wiki/Scriptapedia
OVERVIEW 1. Background a. Obesity prevention in early childhood b. Group model building (GMB): what, why, and how 2. “Shape Up Under 5” case study 3. Benefits and challenges 4. Implications for D&I research
Shape Up Somerville Systems Diagram (2002-2005) Hennessy et al., in preparation
COMPACT Childhood Obesity Modeling for Prevention and Community Transformation Using systems science to understand: what interventions work, for whom, and under what circumstance? 1. Learn from successful, completed whole-of-community interventions 2. Convene a multisector steering committee to design and conduct a new CBPR intervention that promotes healthy weights of young children Systems Science to Drive Whole-of-Community Childhood Obesity Prevention Interventions R01HL115485-04 (NHLBI, OBSSR); 2013-2018
SHAPE UP UNDER 5 COMMITTEE Early Education & Care N = 5 WIC & School 16 Parks & Recreation Nutrition Members N = 2 N = 3 Healthcare Health Department N = 4 N = 2
USE OF GMB IN SHAPE UP UNDER 5 COMMITTEE MEETINGS Meeting theme Objective GMB activity
Meeting theme: Introductions & Setting the Stage Objective: To establish group expectations for committee involvement and community impact GMB activity: Hopes & Fears
Meeting theme: Priority Sharing Objective: To identify early childhood health priorities and connections between them GMB activity: Connection Circles
Meeting theme: Priority Consensus & Intervention Areas Objective: To assess the feasibility and impact of intervention areas GMB activity: Feasibility & Impact Grid
Meeting theme: Early Childhood 9-5-2-1-0 in Action & Committee Roles Objective: To identify potential activities and resources to disseminate a cohesive, whole-of- community obesity prevention campaign GMB activity: Structure Elicitation
Meeting theme: Putting the Committee on the Map Objective: To show how the role of each committee member connects to the system of promoting healthy weight in early childhood GMB activity: Causal Loop Diagram + + Positive + behavior change Visibility of healthy Understanding behaviors in what's good for you community - + - Need for Need for + Availibility of indoor play Commitment to + community indoor play space active play - involvement Cultural and + community Need for + awareness + knowledge + - + + - + + Community + How to talk outreach + about obesity Grassroots power in Use of - + + community to enact + Use of indoor playgrounds + change PA groups Lack of trust in + + Community Integrate in Outdoor play + local institutions Participation in events committee + + community roles + + + + + + Need for food - prep know-how + + - Organizational Educational + pick-up materials Common Screen + Healthy family + messaging time - + culture (95210, Sleep Eat - - + Play) + + + + - - - + Community - + + + - + Measurement of buy-in - + + + + Data from E,S,P organizational - + + implementation change Sleep time - - Embedded + - + + Multiple negative eating jobs + habits City-wide govt + - + + + support Policy or + + Child care Knowledge of program change Competing providers/community + priorities + + Need for resources School services readiness Promotion in social + Family econ. + - + + Caregiver/child Need for support groups + stress knowledge on interactions + food access + + + - + Service outreach Service use + - + and referrals (WIC, SNAP) + Communication Need for to families Potential knoweldge of resources + + development of + eligibility Demand for Parent/family shared materials Engagement of + services (WIC, stress formal/informal care Medical care interactions SNAP) providers (home visits, perinatal, + - pediatrics) - + - - + Shared Quality of Hindered access to Positive care - practices child care informal care-givers experience + + + Coordinated + + + care + + + Professional WORK IN PROGRESS + development
BENEFITS CHALLENGES • Evaluation • Collaborative, multisector efforts • Complexity of models and nonlinear thinking • Awareness of unique stakeholder roles and • Training, expertise, and connections between them facilitation • Buy-in to mental models • Fit within CBPR principles
SUMMARY & IMPLICATIONS • GMB supports effective development of tailored D&I strategies that meet community needs and priorities • Can be used over time to address multiple processes and outcomes • Prioritizes a highly participatory research design with buy- in from key stakeholders • Tool for community-based interventions to tackle complex and dynamic public health problems
THANK YOU! Shape Up Under 5 committee Shape Up Under 5 research team COMPACT colleagues
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