With more than 20% of preschool children and almost 50% of women of childbearing age in Australia either overweight or obese, there is mounting pressure on public health policy and primary care practitioners to work with parents to enhance healthy family behaviours.1 In practice, however, a variety of system-level barriers, attitudinal and behavioural barriers, and knowledge, skills and training barriers prevent effective engagement between parents, primary health care practitioners and other child care providers.2
The SCOPE Project was a collaborative intervention in the Western Australian (WA) primary care sector, focused on promoting healthier family lifestyles for parents of young children. The aim was to engage key stakeholders in the development of a robust plan for collaborative, feasible action that builds on existing services, uses consistent messages and strengthens service provider networks.
The International Obesity Taskforce (IOTF) Planning Framework3 was used to provide key government and non-government stakeholders with an opportunity to participate in a systematic process to develop a plan of action for the promotion of healthy weight among young children. The project, in one rural and three urban communities in WA, involved stakeholders from 19 government and non-government organisations and 76 primary health care providers.
The project began with a series of consultative forums, roundtable discussions and individual meetings with stakeholders and primary care providers in maternal and child health to identify current services in WA, as well as major barriers and potential approaches to improve collaboration. This process was informed by an international literature review, a modified Delphi study of Australian primary health care providers' needs, and 36 focus groups with parents and child care providers across Australia, aimed at identifying promising interventions that enhance parent engagement and cross-sector collaboration in obesity prevention. Interventions were assessed against selection criteria agreed by participants including evidence or promise of effectiveness, feasibility and sustainability, as well as the capability to build on existing services, use consistent messages, strengthen collaboration and support service provider networks within WA. Stakeholders reached a unanimous decision to develop an online resource as an effective way for health professionals to engage and support pregnant women and first-time mothers.
Fifteen focus groups and more than 100 interviews involving 168 pregnant women and parents of newborn children helped clarify what online information parents felt was most needed, how best this information could be delivered, and by whom. The results were used to perform a gap analysis of existing perinatal health websites to determine how the online resource could best meet user needs.
The findings indicated that parents wanted smartphone apps with links to websites containing short, easy-to-read answers to everyday questions; information on events in their local area; links to further resources; and practical, personalised tools to assess and improve their nutrition, fitness and weight. The project's output was the development of the Ngala Healthy You, Healthy Baby website and smartphone app (http://www.ngala.com.au/hyhb). This clinically endorsed, interactive online resource for pregnant women, first-time mothers and their providers builds on existing well-used Ngala services, with links to other service websites to promote consistent messages and strengthen service provider networks.
The content and presentation provides pregnant women and mothers with a tool to track their weight (using a BMI calculator based on the Institute of Medicine recommendations), diet, physical activity, emotional wellbeing, social life and sleep patterns, and is tailored to the developmental stage of their child. It also provides tips on how to improve health and links users to relevant, quality assured information. Mothers can register to use the app and will receive e-mails tailored to their specific needs. The resources are promoted through the media and contact with health care provider services.
The SCOPE project successfully implemented policy-making theory with key stakeholders, which included steps to increase their knowledge base; raise political will to support and generate resources for intervention; and promote a strategy for change by identifying priorities for action and developing a clear plan for implementation.4 Selection of population-wide interventions to prevent overweight and obesity requires consideration of ‘best available evidence’, including implementation issues, not just empirical evidence.3 This requires key stakeholders to come together to formulate a collaborative agreement on what is feasible, relevant and compatible, with the goal of building on current programs and networks rather than focusing on isolated researcher-developed interventions.
The IOTF planning and decision framework builds on the portfolio approach to health promotion planning, with selection of programs based on best available evidence. Within the context of the SCOPE project, the IOTF framework provided a systematic approach that promoted increased collaboration and better co-ordination between primary healthcare providers for the prevention of early childhood obesity. A key success factor was the collaborative participation of senior policy makers and practitioners from the start of the project. Their participation led to considerable sharing of information, and their review and assessment of interventions against agreed criteria helped clarify: what action was relevant, feasible and effective (taking state and national priorities into account); organisational commitment and resource issues; and the likely readiness of practitioners and the community for translation into practice. Moreover, the development of a formal agreement between key stakeholder organisations resulted in strong cross-sector collaboration to ensure that with limited resources, the intervention could be sustained with consistent messages from all stakeholders.