Research Impact
- The RESPOND project was found to have had a “protective effect” on the psychosocial health of children in communities where interventions took place.
- Several observed behaviours known to be associated with obesity or overweight in children changed in the direction that favoured intervention communities.
- Positive effects on health-related quality of life (HRQoL) were observed in intervention communities, especially in boys, who also record a significant increase in water consumption.
- In spite of structural impediments imposed by the COVID-19 pandemic and significant bushfires impacting many target communities, researchers were able to adapt their methodology to produce evidence to support the efficacy of community-led interventions informed by system-based thinking as a key tool to address the issue of childhood obesity.
- Upskilling of teams from 10 local government authorities and over 14 community health services in System Science and Implementation, enabling them to develop their own community-led systems interventions.
The Need/Challenge
On average, 26% of Australian children aged 2-17 experience obesity or being overweight, according to the Australian Institute of Health and Welfare. Further, it is estimated the issue of obesity costs the Australian economy around $21 billion annually in direct and indirect health costs among adults [1]. It is believed that experiences of obesity or overweight in childhood may significantly impact the quality of life, and physical and mental health, of those impacted throughout their life.
Childhood and adolescence are seen as a critical window for obesity prevention, as childhood obesity frequently persists into adulthood [2], as do associated health behaviours established during early life including diet and physical activity [3]. However, childhood obesity is a complex health issue that is influenced by a range of social, economic, and environmental variables, as well as an individual’s biology.
Unlike other jurisdictions including England, many US states, Singapore, Sweden, and The Netherlands [4], Australia has lacked a system to examine obesity trends in the population, identify areas of high risk or emerging disparity, support interventions, and inform policy.
The Ovens Murray and Goulburn Valley Health Behaviours Monitoring Study was created as part of the RESPOND Partnership Project. Its aim was to generate better understanding of the current state of children’s health, and provide real-time data to support and inform the work of the RESPOND communities across the Ovens Murray and Goulburn Valley regions of Victoria.
Goals of the study included to evaluate the impact of community-led interventions to guide planning and implementation measures, accelerating the uptake of efforts to prevent childhood obesity at regional scale.
Developing the solution
With the support of the Global Centre for Preventive Health and Nutrition Research (GLOBE) at Deakin University’s Institute for Health Transformation (IHT), the Ovens Murray and Goulburn Valley Health Behaviours Monitoring Study encompassed 12 Local Government Authorities (LGAs) from the Ovens Murray and Goulburn Valley regions of Victoria, including 116 schools, reaching more than 30,000 children.
The study built on GLOBE’s 15-year history of working in partnership with regional Victorian communities to deliver community-led health promotion/ prevention initiatives, including small trials with pilot sites in Greater Shepparton and Moira. The anthropometric and behavioural monitoring system was expanded to encapsulate the entire Ovens Murray and Goulburn Valley regions.
The study set out to test whether building capacity of key community health staff at-scale could create a sustainable model to deliver systems-based interventions for childhood obesity prevention.
To support this, data was collected in 2019 and again in 2022 from Grade 2, 4 and 6 students, to examine changes in children’s weight and health behaviours across four domains: food and drink consumption, physical activity and screen time, sleep and wellbeing, and healthy weight (BMIz). Participants’ height and weight were measured, and grade 4 and 6 students were invited to complete a questionnaire.
Between the 2019 and 2022 data collections, the RESPOND Partnership Project implemented a number of community-based interventions. This comprised a multi-stage process where community members (leaders and staff of health and community service organisations) were supported to use community-based systems dynamics to design and implement community-led, locally tailored actions for childhood obesity prevention.
Examples from the town of Mansfield’s RESPOND project included an Active Footpaths Project to promote incidental and affordable physical activity, a Fresh Food Drive to encourage local fruit and vegetable growers to donate excess produce to families in need, and a Soup for Schools project to help promote vegetable consumption among local children. Free webinars also provided support on issues including behavioural change and positive parenting, and advice to promote better nutrition and greater physical movement. Other interventions included upskilling locally-based health promotions officers and implementing capacity-building programs.
Facilitators also introduced STICKE (Systems Thinking and Community Knowledge Exchange), a software tool developed by Deakin’s Institute for Intelligent Systems, Research and Innovation (IISRI). This software supported the delivery of a systems dynamics process called Group Model Building (GMB), allowing local communities to brainstorm, communicate, and achieve consensus on problems, policy and program initiatives.
The RESPOND study was planned as a four-year stepped-wedge cluster-randomised childhood obesity prevention trial, with interventions planned to be commenced in five LGAs in July 2019 (step one) and a further five in July 2021 (step two). Pandemic-related public health measures meant the intervention was paused, with only step one LGAs reaching a stage where they had just completed GMB. These became ‘intervention communities’, while a delay in data collection in step two LGAs to 2022 meant these became ‘control communities’, refocusing the study to compare intervention versus control communities over three years (2019 to 2022).
Outcomes
The results of data collection covering demographic characteristics, anthropometric measurements, health-related quality of life (HRQoL), physical activity, sedentary screen time, sleep, and diet intake were analysed as a cluster parallel randomized trial. Of the 67 schools to have participated in the first data collection in 2019 and 34 schools in 2022, a total of 31 schools which had student participating in both time points were selected to be included in the final analysis to avoid bias.
Key findings included:
- Within intervention communities, across time (2019 to 2022), non-significant decreases in BMIz and percentage with overweight or obesity were observed. For control communities, across time, there were non-significant increases in BMIz and percentage with overweight or obesity. No significant intervention effects were observed but the effects were in the expected direction.
- For boys, there was a significant intervention effect for water consumption favouring intervention communities (no significant intervention effects observed for girls).
- In HRQoL measures, significant intervention effects in favour of intervention communities were found for the psychosocial health summary score and total scale score. These effects were weighted towards boys.
Overall, the RESPOND project was found to have had positive effects on HRQoL (psychosocial health and total scale score for boys) and water consumption (for boys). There were also non-significant declines in several key obesity-related behaviours (physical activity, recreational screen time, infrequent takeaway food consumption) for children in both intervention and control communities, coinciding with the COVID-19 pandemic.
Although not significant, shifts in BMIz, the prevalence of overweight and obesity, and several behavioural outcomes (active transport to and from school, sleep, and consumption of takeaway food and sweetened drinks) were in the direction anticipated if the intervention were to succeed.
The findings from RESPOND reinforce systematic review evidence that whole-of-systems approaches can be effective for tackling obesity. The data also presented evidence that RESPOND interventions helped to protect children’s psychosocial health against the effects of COVID-19 lock-down measures, in addition to exposure to overweight/obesity and worsening HRQoL.
The outcome report into the efficacy of the RESPOND project concluded: “The findings from RESPOND support the case for investment in broader training of community health workers in systems thinking, and creating a system where lessons can be learned and shared quickly.”
It also found that: “Despite pandemic-related public health measures adversely affecting children’s health, RESPOND had a protective effect on the psychosocial health of children.”
Community reaction to the RESPOND project:
“We’ve always known that rural and regional kids have poorer health outcomes than our metropolitan counterparts. So the RESPOND project has actually been able to give us some concrete evidence to say, well, in actual fact, that’s right.” Gabriella Tange, Beechworth Health Service
“I think working with Deakin has given us some really tangible tools to be able to introduce systems based thinking and make it real and meaningful for the community and how they can then take action to make change.” Zoe Gephart, Indigo North Health
Project details
Project Title
Reflexive Evidence and Systems Intervention to Prevent Obesity and Non Communicable Disease (RESPOND) Project
Project Time Period 2019 to 2022
Funding
RESPOND (Reflexive Evidence and Systems Intervention to Prevent Obesity and Non Communicable Disease) is funded by a National Health and Medical Research Council Partnership Project Grant (APP1151572).
Research Lead
Professor Steve Allender, Professor of Public Health, Institute for Health Transformation
Partners and supporters
- Victorian Department of Health
- Victorian Department of Education and Training
- VicHealth
- Goulburn Valley Primary Care Partnership
- Central Hume Primary Care Partnership
- Upper Hume Primary Care Partnership
- Lower Hume Primary Care Partnership (PCPs now Goulburn Valley Public Health Unit and Ovens Murray Public Health Unit)
- Alexandra District Health Service
- Yarrawonga Health
- Nathalia Cobram Numurkah Health Services
- Beechworth Health Service
- Gateway Health Service
- Nexus Primary Health
- Greater Shepparton City Council
- Murrindindi Shire Council
- Goulburn Valley Health
- Primary Care Connect
More Information:
Deakin University Institute for Health Transformation – RESPOND
[1] Colagiuri S, Lee CM, Colagiuri R, et al. The cost of overweight and obesity in Australia. Med J Aust 2010; 192: 260-4.
[2] Singh AS, Mulder C, Twisk JWR, van Mechelen W, Chinapaw MJM. Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Reviews 2008; 9: 474-88.
[3] Craigie AM, Lake AA, Kelly SA, Adamson AJ, Mathers JC. Tracking of obesity-related behaviours from childhood to adulthood: A systematic review. Maturitas 2011; 70: 266-84.
[4] Strugnell C, Baldwin R, Nichols M, Anathapavan J. Scoping paper: To examine whether population-level surveillance of BMI (Body Mass Index) with accompanying feedback letters to parents/guardians influences the weight status of school-children. 2018
