Reflection on the socio-ecological model (SEM)
Moving on from our previous discussions on self-responsibility and the role of the individual in obesity prevention, I paused to reflect on the socio-ecological model (SEM) once again, specifically how we enable individual behaviour change through their networks and relationships with friends, family, health care providers, community health workers, etc. This is referred to as the interpersonal level within the SEM, and usually invokes a group-based program or activity response.
An example of such a response...
The Healthy Communities Initiative (HCI) is a prime example with a goal to increase the numbers of ADULTS, predominantly not in the paid workforce, to engage in healthy eating and physical activity programs and activities; with six nationally available programs being recommended.
The final (third) cycle of funding is drawing to an end and HCI Coordinators are writing up their final reports. So it’ll be a while yet before we know the impact of the HCI. In the interim though, CO-OPS has heard from many HCI Coordinators about the variety of strategies being implemented across the local government sites. Read the latest CO-OPS case studies about the HEAL program and how this was expanded into a national licence-based model and how it was implemented at a local level.
Two questions come to mind if we were going to repeat this type of funding?
A) What about infants, children and young people? What interpersonal level programs would be recommended to target them specifically?
Here are some evaluated programs that align with what the evidence suggests:
Community-based mother’s groups promoting breastfeeding and infant healthy eating practices:
INFANT - To influence parents’ knowledge and parenting confidence and improve lifestyle behaviours of parents and children, by promoting healthy eating and active play behaviours; the program consists of six sessions delivered to parents of young infants over the first 18 months of the child’s life.
Growing Strong - Developed for Aboriginal and Torres Strait Islander families; health staff members talk to families about nutrition for mothers, babies (breastfeeding and the introduction of solids) and young children. Resources include brochures, information booklets and flipcharts.
Fun not Fuss with Food - Health staff provide nutrition information for parents. Resources include a presentation, DVD and parent resource kit (fact sheets), tips for child friendly meals, food activities and games, healthy nutrition ideas.
Culturally appropriate family-focused weight management programs:
Parenting, Eating and Activity for Child Health (PEACH) - A whole-of-family approach to support families to manage their child’s weight by upskilling in nutrition, parenting and problem solving; the website contains resources such as nutrition and activity guidelines, healthy lunch box ideas, recipes, ideas to be physically active at home.
B) What’s the effectiveness of an interpersonal level program response in changing health outcomes in relation to overweight and obesity?
In relation to healthy lifestyle programs, cost-effectiveness reports have found that diet and exercise interventions targeted at overweight and obese people in primary care settings, while cost-effective, have only a minor impact on population health outcomes as the weight lost is regained within a few years on average. When considering physical activity interventions, pedometer challenges and mass media-based community campaigns were cost-saving but would be best followed up a program to encourage more active transport, such as TravelSmart. For more inforrmation ACE-Prevention report & Systematic Review
In conclusion then, future funding should provide opportunity to implement multiple complementary interventions simultaneously, targeting high-risk individuals through group-based management and treatment programs, and reaching at-risk individuals through population approaches at the organisational, community and policy level.