Michelle Jones

BMI, Health Behaviors, and Quality of Life in Children and Adolescents: A School-Based Study

OBJECTIVE: To explore the relationship between weight status (BMI) and health-related quality of life in children and adolescents through application of the Child Health Utility 9D, a new generic preference-based instrument. METHODS: Data were collected from primary and high school students in rural and metropolitan regions of South Australia. Consenting participants (2588 in grades 4–6 and 765 in grades 9–10) were weighed and measured and categorized as underweight, healthy weight, overweight, or obese according to International Obesity Taskforce BMI cutoff points (primary outcome). Participants also completed a questionnaire including the Child Health Utility 9D and standardized measures of physical activity, sedentary behavior, sleep patterns, and eating behavior (secondary outcomes). Descriptive and multivariate linear regression analyses were undertaken to calculate mean utility differences. RESULTS: In comparison with healthy-weight primary school students, adjusted mean utilities were lower for overweight (−0.016, P = .02) or obese (−0.039, P = .001) students. For high school students, the adjusted mean utilities were also lower for overweight and obese students but were nonsignificant (−0.018, P > .10). Physical activity, sedentary behavior, sleep patterns, and eating behavior were all found to be significantly associated with utilities. CONCLUSIONS: Irrespective of BMI, young people engaging in more physical activities or less sedentary behavior, and having healthier sleep patterns or eating behavior exhibited higher utilities. Associations between utilities and sleep patterns or eating behavior were stronger than the associations with BMI. Future economic evaluations for obesity interventions should more formally investigate the relationship between changes over time in weight status and health-related quality of life for children and adolescents.

The challenges of quantitative evaluation of a multi-setting, multi-strategy community-based childhood obesity prevention programme: lessons learnt from the eat well be active Community Programs in South Australia

OBJECTIVE To describe the rationale, development and implementation of the quantitative component of evaluation of a multi-setting, multi-strategy, community-based childhood obesity prevention project (the eat well be active (ewba) Community Programs) and the challenges associated with this process and some potential solutions. DESIGN ewba has a quasi-experimental design with intervention and comparison communities. Baseline data were collected in 2006 and post-intervention measures will be taken from a non-matched cohort in 2009. Schoolchildren aged 10-12 years were chosen as one litmus group for evaluation purposes. SETTING Thirty-nine primary schools in two metropolitan and two rural communities in South Australia. SUBJECTS A total of 1732 10-12-year-old school students completed a nutrition and/or a physical activity questionnaire and 1637 had anthropometric measures taken; 983 parents, 286 teachers, thirty-six principals, twenty-six canteen and thirteen out-of-school-hours care (OSHC) workers completed Program-specific questionnaires developed for each of these target groups. RESULTS The overall child response rate for the study was 49 %. Sixty-five per cent, 43 %, 90 %, 90 % and 68 % of parent, teachers, principals, canteen and OSHC workers respectively, completed and returned questionnaires. A number of practical, logistical and methodological challenges were experienced when undertaking this data collection. CONCLUSIONS Learnings from the process of quantitative baseline data collection for the ewba Community Programs can provide insights for other researchers planning similar studies with similar methods, particularly those evaluating multi-strategy programmes across multiple settings.

Assessing implementation fidelity and adaptation in a community-based childhood obesity prevention intervention

Little research has assessed the fidelity, adaptation or integrity of activities implemented within community-based obesity prevention initiatives. To address this gap, a mixed-method process evaluation was undertaken in the context of the South Australian Obesity Prevention and Lifestyle (OPAL) initiative. An ecological coding procedure assessed fidelity and adaptation of activity settings, targets and strategies implemented in the second year of four communities. Implementation integrity reflected fidelity and adaptation to local context, whereas efforts resulting in significant deviations from the original plan were deemed to lack fidelity and integrity. Staff implemented 284 strategies in 205 projects. Results show that 68.3 and 2.1% of strategies were implemented with fidelity or adapted, respectively. Overall, 70.4% of all strategies were implemented with integrity. Staff experienced barriers with 29.6% of strategies. Chi-square analyses show statistically significant associations between implementation integrity and strategy type, intervention and behavioural targets. These relationships are weak to modest. The strongest relationship was found between implementation integrity and proximal target. Staff experienced implementation barriers at the coalition, policy, organization, interpersonal and community levels. The greatest range of barriers was encountered working with organizations. To overcome these barriers, staff took greater ownership, invested more time, persisted and allocated more financial resources.

OPALesence: Epistemological pluralism in the evaluation of a systems-wide childhood obesity prevention program

The evaluation of complex systems-wide public health interventions requires evaluation research that is underpinned by theory. This article presents and discusses the trans-disciplinary evaluation research framework developed to support the evaluation of a South Australian program called OPAL (Obesity Prevention and Lifestyle). The aim is to provide insights into the research design, methods and implementation of the evaluation and contribute to the debate on how to evaluate community-based interventions with complicated and complex aspects. In an attempt to capture the complexity of childhood obesity and the intervention, the OPAL evaluation research employs post positivist, interpretive and critical epistemologies, valuing epistemological pluralism. Each component of the multi-phase mixed methods evaluation captures different yet complementary information concerning the context, process, cost effectiveness and outcomes providing a more complete understanding of the impacts of the complex program. Evaluation research is not without challenges. Some of the tensions and challenges that arose in the establishment, planning and conduct of the OPAL program and evaluation are discussed.

Assessing change in perceived community leadership readiness in the Obesity Prevention and Lifestyle program

Issue addressed The context of community-based childhood obesity prevention programs can influence the effects of these intervention programs. Leadership readiness for community mobilisation for childhood obesity prevention is one such contextual factor. This study assessed perceived community leadership readiness (PCLR) at two time points in a state-wide, multisite community-based childhood obesity prevention program. Methods PCLR was assessed across 168 suburbs of 20 intervention communities participating in South Australias Obesity Prevention and Lifestyle (OPAL) program. Using a validated online PCLR tool, four key respondents from each community rated each suburb within their respective community on a nine-point scale for baseline and 2015. Average PCLR and change scores were calculated using the general linear model with suburbs nested in communities. Relationships between demographic variables and change in PCLR were evaluated using multiple regression. Ease of survey use was also assessed. Results Average PCLR increased between baseline (3.51, s.d.=0.82) and 2015 (5.23, s.d.=0.89). PCLR rose in 18 of 20 intervention communities. PCLR was inversely associated with suburb population size (r2=0.03, P=0.03, β=-0.25) and positively associated with intervention duration (r2 change=0.08, P=0.00, β=0.29). Only 8% of survey respondents considered the online assessment tool difficult to use. Conclusions PCLR increased over the course of the OPAL intervention. PCLR varied between and within communities. Online assessment of PCLR has utility for multisite program evaluations. So what? Use of a novel, resource-efficient online tool to measure the key contextual factors of PCLR has enabled a better understanding of the success and generalisability of the OPAL program.

Physical Bruises, Emotional Scars and ‘Love-Bites’: Women’s Experiences of Men’s Violence

Marks on human bodies can have many identifiable social and public meanings (Lingis, 1984: 22). Various forms of ‘body writing’ and techniques of social inscription are practised in many cultural contexts, including violent ones. This chapter explores the body of the female victim of violence from men known to them as partners or ex-partners. It analyses the personal and social meanings of physical marks, such as bruises and love bites, as well as the ways in which emotional scars can manifest themselves in and on the physical body. Men’s violence to known women remains an urgent social question; women form the vast majority of victims of men’s violence (Taft et al., 2001; Kimmel, 2002). Men continue to perpetrate most interpersonal violence in intimate relationships, especially planned, repeated, heavy, physically damaging, nondefensive, premeditated, non-retaliatory and sexual forms of violence, along with most economic, collective, institutional, organised and military violence, which themselves are usually also interpersonal (Hearn and McKie, 2008).

Fat as Productive: Enactments of Fat in an Australian Suburb

ABSTRACT By foregrounding positive and productive capacities of fat, we explore experiences of expanding, maintaining, or diminishing body sizes to accommodate the different meanings and enactments of fat. Drawing on fieldwork conducted in a South Australian community that has experienced significant socioeconomic disadvantage, we detail how the “problem” of fat in public health discourse is countered in the lived experience of people targeted for obesity intervention. In so doing, we attend to the multiple meanings and practices of fat that differ to the focus within public health interventions on the negative health consequences of overweight and obesity.

Working at the interface in Aboriginal and Torres Strait Islander health: focussing on the individual health professional and their organisation as a means to address health equity

BackgroundAboriginal and Torres Strait Islander people experience inequity in health outcomes in Australia. Health care interactions are an important starting place to seek to address this inequity. The majority of health professionals in Australia do not identify as Aboriginal and/or Torres Strait Islander people and the health care interaction therefore becomes an example of working in an intercultural space (or interface). It is therefore critical to consider how health professionals may maximise the positive impact within the health care interaction by skilfully working at the interface.MethodsThirty-five health professionals working in South Australia were interviewed about their experiences working with Aboriginal people. Recruitment was through purposive sampling. The research was guided by the National Health and Medical Research Council Values and Ethics for undertaking research with Aboriginal communities. Critical social research was used to analyse data.ResultsInterviews revealed two main types of factors influencing the experience of non-Aboriginal health professionals working with Aboriginal people at the interface: the organisation and the individual. Within these two factors, a number of sub-factors were found to be important including organisational culture, organisational support, accessibility of health services and responding to expectations of the wider health system (organisation) and personal ideology and awareness of colonisation (individual).ConclusionsA health professional’s practice at the interface cannot be considered in isolation from individual and organisational contexts. It is critical to consider how the organisational and individual factors identified in this research will be addressed in health professional training and practice, in order to maximise the ability of health professionals to work with Aboriginal and Torres Strait Islander people and therefore contribute to addressing health equity.