Colloque RI 2014 : Intervention de Kim RAINE, PhD, (School of public health, University of Alberta)

Centre for Health Promotion Studies

Community engagement and policy advocacy approaches to obesity and chronic disease prevention

Kim Raine, PhD, RD, FCAHSProfessorCIHR/HSFC Applied Public Health Chair (2008-13)


• Community engagement represents an approach for environmental change to promote healthy living.

• case of "Healthy Alberta Communities"

• Designing research and evaluation to create an evidence base for influencing policy and practice is challenging:

• how do communities change? • how does transforming environments influence

health?• Local communities' action can gain support through

policy to address the underlying drivers of unhealthy eating, physical inactivity, and obesity.

Key messages:

Alberta

• Politically conservative

• Oil rich

• Rugged individualism

• Trail blazers

• Leaders in Tobacco control


• Comprehensive 5 year community-based intervention for obesity and chronic disease prevention (2005-10)

• University-community-government partnership

• 4 unique communities

• Goals:

• Support environmental change within communities to promote and support healthy choices

• prevent obesity, improve health, prevent chronic diseases• Inform policy, practice, and research decisions

Raine, K.D., et al. Reflections on community-based population health intervention and evaluation for obesity and chronic disease prevention: the Healthy Alberta Communities project. International Journal of Public Health. 2010, 55(6)679-686.

Baseline Chronic Disease Risk Factors: Community Reports


• Target community environments

• Leverage resources and rely on the work of individuals, groups and organizations already in the community

• Hire community coordinators

• Invest seed money to help kick-start activities and maintain momentum

How to Build Healthy Communities?


Workshops for Capacity- Building and Intervention Development

ANGELO (Swinburn et al)

Flaman, Plotnikoff, Nykiforuk & Raine. Mechanisms for Understanding the Facilitators and Barriers to Capacity Building for Chronic Disease Prevention Activities: An Illustration. Health Promotion Practice. November 2011vol. 12 no. 6 858-866.

Taking Action in BonnyvillePriority: Healthy choices available in local restaurants

Restaurant Program

Three restaurants initiated participation – Developed to meet the needs of transient workers without

kitchens. Developed criteria for participation with AHS Dietitian. Promoted program to local restaurants. Addressed concerns of restaurant owners (newspaper articles

and radio ads). Branded the program. Expansion into neighboring community.Sustainable

Taking Action in Norwood/ North Central Edmonton:

The Good Food Project

Priority: Support food security

• Urban social enterprise project

• Supports local food production and household food security

• An alternative to charitable models to address hunger.

• Sustainable in 2010!

Taking Action in Medicine Hat:Priority: Promote alternative transportation, including walking

and cycling

Coalition for Active & Alternate Transportation (CAAT)

Networking and partnering with KEY stakeholders to develop and implement municipal projects such as: "Leisure Trail Master Plan" and "Cycling Trail Master Plan“ to attract more citizens to active transportation

Now sustained by the local Be Fit for Life Centre








Key messages:


• Can community-based interventions reduce obesity and chronic disease risk?

• What is the impact of the interventions on obesity and chronic disease risk factors in HAC communities as compared to secular trends in Alberta?

• How have the interventions contributed to changes in community capacity and environments?

Research Questions

Evaluation Activities (2006 - 2009)

• Impact evaluation– Phone survey

(perceptions & behaviors)

– Measurement clinics (health outcomes)

• Community evaluation– Outcome– Process


Study DesignRaine, K.D., et al., Healthy Alberta Communities: Impact of a three-year community-based obesity and chronic disease prevention intervention, Prev. Med. Volume 57, Issue 6, December 2013, Pages 955–962.

http://www.sciencedirect.com/science/journal/00917435/57/6


• Self-reported well-being outcomes showed improvement in comparison to secular trends

• Impact on behavior change not evident

• Impact on BMI/ overweight/ obesity not evident

• Translating changing environments into behavior change and health impact is slow (unable to secure funding for additional 3 years of research, “not novel”)

Did we make a difference?

Change in sense of belonging to community

3.65 %

-2.19 %

-4

-3

-2

-1

0

1

2

3

4

5

←V

ery

we

akV

ery

str

on

g→

HAC 2006→2009

Alberta-CCHS 2005-2006→2007-2008

Change in Food Security2.38 %

0.89 %

-0.5

0

0.5

1

1.5

2

2.5

←O

fte

n d

id n

ot

hav

e en

ou

ghA

lway

s h

ave

en

ou

gh o

f an

y fo

od

wan

ted

→

HAC 2006→2009

Alberta-CCHS 2005-2006→2007-2008

Self-Report Overweight and Obesity (HAC vs. CCHS)

Healthy Alberta Communities (HAC) Compared to CCHS Alberta,Adult (18+) Percentage Overweight and Obese with 95%CI,2003 - 2009

Year

2003 2004 2005 2006 2007 2008 2009

Pe

rce

nta

ge

10

15

20

25

30

35

40

CCHS Alberta Overweight

CCHS Alberta Obese

CCHS Alberta Trend

HAC Overweight

HAC Obese


• Helped to advance understandings of how communities change

• Demonstrated the value of a partnerships that value the knowledge and expertise within the community

• Demonstrated sustainability and justified expansion to other communities (AHS)

Community Evaluation

Montemurro, Raine, Nykiforuk & Mayan. Exploring the process of capacity-building among community-based health promotion workers in Alberta, Canada. Health Promot. Int.

(2014) 29 (3):463-473.doi: 10.1093/heapro/dat008

www.healthyalbertacommunities.com


• Important to use target of intervention as key indicators of impact of community-based interventions (Role of place) – see Nykiforuk et al. Community Health and the Built Environment: examining place in a Canadian chronic disease prevention

project. Health Promot. Int. (2013) 28 (2):257-268.

• Communities need support (policy)

Community Evaluation (2)








Key messages:

www.abpolicycoalitionforprevention.ca

• Applying lessons from tobacco control to physical activity and nutrition

• APCCP – funded 2009-11 by ACPLF. Ongoing funding from HSF


• Restrict unhealthy food and beverage advertising targeting children

• Promote policies on urban design and zoning that promote active living and healthy eating.

• Encourage financial incentives and disincentives to promote healthy living

Policy Approaches for Environmental Change


Synthesize evidence: obesity-relevant policies

Broker knowledge for policy development

Build capacity for policy adoption and implementation

Policy Interventions to Reduce Obesity (CPAC - 2013-16)


Complex system problems• No “one” solution to social and behavioural determinants of health

• Individual, community and policy interventions alone are not enough, but in synergy may be points of access to social change

• Need flexible interventions to consider context and capture complexity

• Need more complex designs, plurality of methodologies and non-traditional funding mechanisms to study interconnections among parts of the system

Engaged Scholarship• Researchers, practitioners and policy-makers are jointly involved in

each step of the process, from initial design to end-stage implementation

Lessons Learned: Future of Population Health Interventions

Merci Beaucoup!

(HAC)(HAC)Health and Wellness

Colloque RI 2014 : Intervention de Kim RAINE, PhD, (School of public health, University of Alberta)

Health & Medicine

Transcript of Colloque RI 2014 : Intervention de Kim RAINE, PhD, (School of public health, University of Alberta)