The consensus that obesity is a complex problem has led to calls for ‘whole of system’ approaches to intervention that address multiple levels of influence, from individual behaviours through to policy change.1 In this letter, we provide a case study applying a systems perspective to identify influences on childhood obesity and determine potential system-level points for intervention2 within the long day care setting.
Two long day care centres from previously successful obesity prevention interventions were recruited to allow discussion with childcare practitioners receptive to obesity prevention opportunities. Interviews were conducted separately with the regional childcare co-ordinator and a centre director, and a joint interview was held with a centre director and cook. Interview guides were based on a systems framework covering: organisation (reporting structure), network (working relationships) and knowledge (e.g. policy/guidelines) elements3 with reference to centre influences on children's eating and activity behaviours. Qualitative interview data were used to compile system maps.
Influences on children's dietary and activity behaviours were identified within multiple system elements (Figure 1). Participants described how existing systems promote healthy dietary and activity behaviours, including “a very strong commitment at a local government level to health and well-being” (regional childcare co-ordinator), a supportive management structure, collaborative policy development and continued implementation of integrated physical activity and nutrition programs. These programs were instrumental in interpreting and applying national childcare guidelines and giving rise to a nutrition program childcare centre ‘champion’, providing evidence that centre ‘systems’ were amenable to change. Promoting health and well-being within the early childhood community was also a priority of the centres, providing some insight to the extent of network influence.
An emphasis on what works for finding solutions to complex system problems has been proposed as a basis for identifying a hierarchy of places to intervene in a system.2 Results from this study can be aligned against each level of the hierarchy suggesting potential for multi-component policies and programs supporting change ‘across the system’. This case study demonstrates capacity for applying a systems framework from a practitioner's perspective, breaking down the complexity of a long day care system, and identifies possible leverage points for effective change for the prevention of obesity in children.