Can we prevent obesity through community interventions?
Authors: Jessica Gubbels, Maastricht University and
Dr Tim Lobstein, Director of Policy, World Obesity Federation
The winter sees the completion of the SPOTLIGHT project, a European Community-funded project designed to study the nature obesogenic environments and the challenges of undertaking community interventions.
The goal of one part of the project (work package 5) was to provide an overview of the characteristics and potential impact of obesity-prevention multi-level interventions that have been implemented recently in the EU. Collecting information on these interventions proved to be a difficult, time consuming and painstaking process, combining step-wise approaches to keep the burden on participants to a minimum. Details regarding the methodology, the challenges met, and the valuable lessons that were learned during this process, have been published by Gubbels et al. (2015)
We identified nearly 80 projects around Europe, and used the RE-AIM framework to assess each intervention’s potential impact. Our findings matched the findings of a systematic review (Compernolle et al., 2014), which showed that information was most easily found regarding the Reach of community interventions, followed by Implementation, with limited information on Effectiveness, and little on Adoption or Maintenance.
The findings on each of the interventions have been summarized in an interactive Web-atlas, presenting all of the 78 included interventions. The Web-atlas provides both practitioners and scientists with information to help them evaluate the relevance and appropriateness of intervention components and RE-AIM summaries. With this information practitioners can learn from others´ practices across Europe and decide if and how to adopt the interventions for their local context. Moreover, researchers can use the information to identify promising intervention and implementation components and which will benefit from adaptations and which will not. In order to improve the evidence base, practitioners and researchers should jointly develop and evaluate new interventions that meet the practitioners’ knowledge of what works in the real world and that still comply with researchers’ knowledge of theory and empirical research. In order to improve the evidence base, we recommend that all practitioners give priority to sharing their experiences and practices. We also recommend that funding agencies should ensure that resources are available to evaluate community-based initiatives, and to share the evaluation with other projects.
Our investigation into the community interventions found that the staff running the interventions were frequently unwilling to participate in our survey, and not comfortable with the RE-AIM questions for evaluating the project’s impact. We found it helpful to encourage the staff by drafting the responses we expected from them and asking them to confirm or alter the drafts.
A second strand of the SPOTLIGHT project (work package 6) aimed to look in more detail at the challenges and barriers facing community interventions and the factors for success, using three in-depth case studies, one each in the Netherlands, the UK and Denmark. Several key factors for successful adoption and implementation were identified.
The first is resources. Money is clearly important, but even more important is that the funding should continue reliably throughout the project. For example, any threats to financial security, such as potential changes in government, can shake the confidence of other funding partners. Threats of this type will also delay the project, and this can have severe consequences for infrastructure work.
Another key factor is community involvement. Previous research has shown repeatedly the importance of having members of the local community participate in the intervention at the start, when the project is being designed and planned. All three case studies failed in this to some extent, with problems when the projects were seen as imposed in a ‘top down’ manner, largely because of the nature and restrictions of the funding received, and particularly because of the tight timescales imposed on the projects.
A third factor was a conflict between rapid delivery versus long-term maintenance of a project. There are conflicts between delivering a good quality and effective project in a short period of time on the one side, and success factors for truly engaging the community and its organisations and leaders on the other. Full community engagement means a slow but well-adopted initiative, which in time can become embedded and continue to contribute to the health of the community after the specific intervention has ceased. Further details of these conclusions can be found here.
The findings of the SPOTLIGHT project provide valuable intelligence for health promotion practitioners as well as scientists working in the field of obesity prevention, in all phases from intervention development to maintenance of successfully implemented interventions. Key factors for success and potential pitfalls that should be avoided have been identified. We urge everybody involved in obesity prevention to consider them seriously.