Louise Farrell

Fundamental movement skills among Australian preschool children.

Early childhood is a critical period for the development of fundamental movement skills (FMS). Children who do not master FMS are more likely to experience failure in the motor domain and less likely to participate in sport and games during childhood and adolescence. Studies among primary school aged children report low levels of FMS mastery indicating the need to implement FMS programs during the preschool years. Cross-sectional study of 425 children attending preschools in the Sydney, Australia in 2008. FMS were assessed using the Test of Gross Motor Development-2 including locomotor (run, gallop, hop, horizontal jump) and object control (strike, catch, kick overhand throw) skills. Data were analysed using linear regression and chi-squared analyses. Total locomotor score was higher among girls compared with boys (p<0.00); however only the hop was significantly different (p=0.01). Boys had higher total (p<0.00) and individual object control scores compared with girls, except the catch (p=0.6). The prevalence of mastery differed across each FMS. Girls generally had higher mastery of locomotor skills and boys had higher mastery of object control skills. These findings highlight the need to provide structured opportunities which facilitate childrens acquisition of FMS, which may include providing gender separated games, equipment and spaces. That mastery of FMS is low in primary school children indicates the importance of early intervention programs in preschools. Preschools and child care centers hold promise as a key setting for implementing FMS programs.

Munch and Move: evaluation of a preschool healthy eating and movement skill program.

BackgroundEarly childhood services have been identified as a key setting for promoting healthy eating and physical activity as a means of preventing overweight and obesity. However, there is limited evidence on effective nutrition and physical activity programs in this setting. The purpose of this study was to evaluate Munch and Move, a low-intensity, state-wide, professional development program designed to support early childhood professionals to promote healthy eating and physical activity among children in their care.MethodsThe evaluation involved 15 intervention and 14 control preschools (n = 430; mean age 4.4 years) in Sydney, New South Wales, Australia and was based on a randomised-control design with pre and post evaluation of childrens lunchbox contents, fundamental movement skills (FMS), preschool policies and practices and staff attitudes, knowledge and confidence related to physical activity, healthy eating and recreational screen time.ResultsAt follow up, FMS scores for locomotor, object control and total FMS score significantly improved by 3.4, 2.1 and 5.5 points more (respectively) in the intervention group compared with the control group (P < 0.001) and the number of FMS sessions per week increased by 1.5 (P = 0.05). The lunchbox audit showed that children in the intervention group significantly reduced sweetened drinks by 0.13 serves (i.e., 46 ml) (P = 0.05).ConclusionThe findings suggest that a low intensity preschool healthy weight intervention program can improve certain weight related behaviours. The findings also suggest that change to food policies are difficult to initiate mid-year and potentially a longer implementation period may be required to determine the efficacy of food policies to influence the contents of preschoolers lunchboxes.

The Sydney Diabetes Prevention Program: A community-based translational study

BackgroundType 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity. Prevention is an essential component of strategies to reduce the diabetes burden. There is strong and consistent evidence from randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet, increases physical activity and achieves weight loss in at risk people. The current challenge is to translate this evidence into routine community settings, determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes.Methods/DesignThe Sydney Diabetes Prevention Program (SDPP) is a translational study which will be conducted in 1,550 participants aged 50-65 years (including 100 indigenous people aged 18 years and older) at high risk of future development of diabetes. Participants will be identified through a screening and recruitment program delivered through primary care and will be offered a community-based lifestyle modification intervention. The intervention comprises an initial individual session and three group sessions based on behaviour change principles and focuses on five goals: 5% weight loss, 210 min/week physical activity (aerobic and strength training exercise), limit dietary fat and saturated fat to less than 30% and 10% of energy intake respectively, and at least 15 g/1000 kcal dietary fibre. This is followed by 3-monthly contact with participants to review progress and offer ongoing lifestyle advice for 12 months. The effectiveness and costs of the program on diabetes-related risk factors will be evaluated. Main outcomes include changes in weight, physical activity, and dietary changes (fat, saturated fat and fibre intake). Secondary outcomes include changes in waist circumference, fasting plasma glucose, blood pressure, lipids, quality of life, psychological well being, medication use and health service utilization.DiscussionThis translational study will ascertain the reach, feasibility, effectiveness and cost-effectiveness of a lifestyle modification program delivered in a community setting through primary health care. If demonstrated to be effective, it will result in recommendations for policy change and practical methods for a wider community program for preventing or delaying the onset of type 2 diabetes in high risk people.

Recent trends in physical activity in New South Wales. Is the tide of inactivity turning

Objective: To examine recent trends in sufficient physical activity among New South Wales adults aged 16 years and over.

Evaluation Framework for Translational Research Case Study of Australia’s Get Healthy Information and Coaching Service®

The Get Healthy Information and Coaching Service® (GHS), a free government-funded telephone-delivered information and coaching service was launched in February 2009 by the Australian New South Wales state government. It represents the translation of research evidence applied in the real world (T4 or Phase 4 translation), aimed at addressing the modifiable risk factors associated with the overweight and obesity. In controlled settings, it has been established that telephone-based lifestyle counseling programs are efficacious in reducing anthropometric and behavioral risk factors. This article presents the GHS case study as a population-wide intervention and describes the quasi-experimental evaluation framework used to evaluate both the process (statewide implementation) and impact (effectiveness) of the GHS in a real-world environment. It details the data collection, measures, and statistical analysis required in assessing the process of implementation—reach and recruitment, marketing and promotion, service satisfaction, intervention fidelity, and GHS setting up and operations costs—and in assessing the impact of GHS—increasing physical activity, improving dietary practices, and reducing body weight and waist circumference. The comprehensive evaluation framework designed for the GHS provides a method for building effectiveness evidence of a rare translation of efficacy trial evidence into population-wide practice.

A practical example of Contribution Analysis to a public health intervention

The theory of Contribution Analysis (CA) as a method of evaluating complex programs has been written about extensively and has evolved considerably since it was first introduced by John Mayne in 1999. We applied Mayne’s six steps to CA and Lemire et al.’s newly proposed framework, the Relevant Explanation Finder (REF), to a state-wide public health intervention delivered in New South Wales, Australia. We argue that CA in conjunction with the REF adds value in improving practitioners’ understanding of the assumptions and underlying mechanisms which influence program delivery and outcomes in real world practice. This participatory process increased practitioners’ ownership and accountability for the program logic and drive for improvement. Although the REF has several methodological benefits we argue that the framework needs to be sufficiently flexible to account for different levels of available evidence and stages of program delivery.

Applying Process Mapping and Analysis as a Quality Improvement Strategy to Increase the Adoption of Fruit, Vegetable, and Water Breaks in Australian Primary Schools

Over the past decade, public health policy in Australia has prioritized the prevention and control of obesity and invested in programs that promote healthy eating–related behaviors, which includes increasing fruit and vegetable consumption in children. This article reports on a study that used process mapping and analysis as a quality improvement strategy to improve the delivery of a nutrition primary prevention program delivered in primary schools in New South Wales, Australia. Crunch&Sip® has been delivered since 2008. To date, adoption is low with only 25% of schools implementing the program. We investigated the cause of low adoption and propose actions to increase school participation. We conducted semistructured interviews with key stakeholders and analyzed the process of delivering Crunch&Sip to schools. Interviews and process mapping and analysis identified a number of barriers to schools adopting the program. The analyses identified the need to simplify and streamline the process of delivering the program to schools and introduce monitoring and feedback loops to track ongoing participation. The combination of stakeholder interviews and process mapping and analysis provided important practical solutions to improving program delivery and also contributed to building an understanding of factors that help and hinder program adoption. The insight provided by this analysis helped identify usable routine measures of adoption, which were an improvement over those used in the existing program plan. This study contributed toward improving the quality and efficiency of delivering a health promoting program to work toward achieving healthy eating behaviors in children.