Originally published on 4/11/2007
I mentioned in a previous post that the fight against childhood obesity leaves many health organizations asking, “How do we reach the greatest number of children in the shortest period of time with the most efficient and sustainable use of resources to combat childhood obesity and promote healthier lifestyles?”
The People and Places Framework helps provide the answer to that question.
1. Define the desired outcome. For example, a population-based target for children within certain BMI (Body Mass Index) ranges and/or targets for certain weight-related morbidities or co-morbidities.
It’s also important to define the desired outcome of a proposed initiative: To foster the ability, opportunity and motivation for our area’s children to lead healthier lifestyles.
2. Define the behaviors that will be required to achieve those outcomes, and the status of those behaviors within the target populations. Children should eat at least 5 servings of fruit and vegetables a day, reduce intake of high calorie/low nutrient food, engage in at least an hour of physical activity daily, and reduce screen time to 2 hours or less. Their parents should take steps to enable these behaviors. Those who advise parents on their children’s health should address healthy lifestyles. And, those in a position to make policy and practice change should make changes to enable healthier lifestyles for kids.
For each of these groups (which may be further refined), status of the behavior can be charted along Prochaska, et. al.’s Five Stages of Behavior Change.
3. Generate possible interventions along the People and Places continuum and assess their relative efficacy. An approach targeting individuals would be largely educational, encouraging an individual to change behavior and/or join a program. An approach targeting groups would be programmatic, providing learning and engagement opportunities and/or leveraging social networking and other connections. An approach targeting populations would likely blend both social marketing and programmatic initiatives.
But what’s the best way to reach the desired outcomes? On one hand, policy or practice change close to where kids learn and develop would be desirable. For example, the elimination of soda machines from schools. But, on a broader scale, statewide policy mandating at least 210 minutes of exercise per week for school children might be seen as having the greatest impact.
In some instances, a population-wide social marketing intervention may make the most sense, especially if the solution to childhood obesity is seen as requiring a set of behavior changes. In others, a policy advocacy intervention may make the most sense, if it is broad enough to affect a key determinant of childhood obesity in an encompassing fashion.
The point is, there’s no single choice of intervention that fits all situations best. The first two steps, rigorously conducted, yield a significant foundation for the design and evaluation of alternative interventions. By using the People and Places Framework, we’re able to develop possible interventions, and the criteria to screen them against.
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