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STRATEGIES FOR EARLY CHILDHOOD OBESITY PREVENTION Ariella Korn, MS, - - PowerPoint PPT Presentation
STRATEGIES FOR EARLY CHILDHOOD OBESITY PREVENTION Ariella Korn, MS, - - PowerPoint PPT Presentation
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
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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
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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?
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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.
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GMB WITHIN A CBPR CONTEXT
- Grounded in community
expertise, experience, and language
- Identifies leverage points,
barriers, and facilitators
- Promotes shared understanding
and empowerment
- Bridges disparate priorities and
builds consensus
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.
Collaboration and trust Community engagement in research process Culturally- centered interventions Partnership dynamics Synergy: partnership + co-learning
+ GMB CBPR
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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
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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
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Hennessy et al., in preparation
Shape Up Somerville Systems Diagram (2002-2005)
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Systems Science to Drive Whole-of-Community Childhood Obesity Prevention Interventions R01HL115485-04 (NHLBI, OBSSR); 2013-2018
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
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SHAPE UP UNDER 5 COMMITTEE
Early Education & Care N = 5 Health Department N = 2 Healthcare N = 4 WIC & School Nutrition N = 3 Parks & Recreation N = 2 16 Members
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USE OF GMB IN SHAPE UP UNDER 5 COMMITTEE MEETINGS
Meeting theme Objective GMB activity
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Meeting theme: Introductions & Setting the Stage Objective: To establish group expectations for committee involvement and community impact GMB activity: Hopes & Fears
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Meeting theme: Priority Sharing Objective: To identify early childhood health priorities and connections between them GMB activity: Connection Circles
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Meeting theme: Priority Consensus & Intervention Areas Objective: To assess the feasibility and impact of intervention areas GMB activity: Feasibility & Impact Grid
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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
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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 WORK IN PROGRESS
Common messaging (95210, Sleep Eat Play) Measurement of
- rganizational
change + Data from E,S,P implementation + + + Community buy-in Need for knowledge Positive behavior change
- How to talk
about obesity + Lack of trust in local institutions
- Need for food
prep know-how +
- +
Shared practices School readiness + Potential development of shared materials + Professional development + Knowledge of providers/community resources + + Quality of child care + Hindered access to informal care-givers
- Engagement of
formal/informal care providers + + City-wide govt support Competing priorities
- +
Policy or program change Need for knowledge on food access + Understanding what's good for you + Visibility of healthy behaviors in community Commitment to active play + Need for indoor play Participation in community Family econ. stress Child care + Need for knoweldge of resources eligibility Need for services Multiple jobs + + Organizational pick-up + Service outreach and referrals + Healthy family culture +
- Community
- utreach
+ Community events + Integrate in committee roles + + Promotion in social support groups + + Educational materials + + + Communication to families + + Outdoor play +
- +
- +
+ Demand for services (WIC, SNAP) + Caregiver/child interactions Screen time
- +
Use of playgrounds + + + + Sleep time
- +
Need for community involvement + Medical care interactions (home visits, perinatal, pediatrics) Parent/family stress
- Coordinated
care
- +
- +
+ + + + + + Service use (WIC, SNAP) +
- +
Grassroots power in community to enact change +
- Availibility of
indoor play space Use of indoor PA groups +
- +
- +
- +
+ + + + + + + Embedded negative eating habits + +
- +
+ + + + +
- +
+ + + + Positive care experience + + + +
- +
Cultural and community awareness + + + + + + + +
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- Collaborative, multisector
efforts
- Awareness of unique
stakeholder roles and connections between them
- Buy-in to mental models
- Fit within CBPR principles
- Evaluation
- Complexity of models and
nonlinear thinking
- Training, expertise, and
facilitation
BENEFITS CHALLENGES
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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
- utcomes
- 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
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