The role of community readiness in the prevention of overweight and obesity in pre-adolescent girls

Overweight and obesity prevention efforts focused on pre-adolescent girls are justified because the health of future mothers can significantly impact the health of their future offspring. Aims and Objectives This thesis aimed to investigate the role of community readiness in the prevention of overweight and obesity in pre-adolescent girls within the Charnwood Borough (Leicestershire) community. Specifically the objectives of this research were to: 1) further the understanding of the concept of community , 2) identify, using focus groups, the key informants and other ecological influences acting on pre-adolescent girls health behaviours, 3) employ the Community Readiness Model (CRM), using key informant interviews, to assess the Charnwood Borough community s knowledge, awareness and readiness to adopt behaviours associated with the prevention of overweight and obesity in pre-adolescent girls, 4) evaluate the usefulness of the CRM for this task and 5) form recommendations for a tailored intervention. Methods This research used focus groups with pre-adolescent girls to identify the key informants who influence their lifestyle choices regarding dietary and physical activity behaviours. The study recruited 56 female participants aged between 6-11 years from 8 primary schools. In total 13 focus groups with between 2 to 7 participants per group were performed. To assess the level of community readiness, 33 key informants identified as informing the health behaviours of pre-adolescent girls were recruited. Semi-structured interviews followed an adapted version of the CRM. The model consists of six dimensions: community efforts; community knowledge of efforts; leadership; community climate; community knowledge of the issue and resources which are scored on a scale of 1 (no awareness) to 9 (high level of community readiness). The average of these scores is the community readiness stage. Findings In relation to the first objective, the definition of a community given by those residing in the Charnwood Borough community included: people and groups of people (e.g. school; religious and parents community groups); characteristics (i.e. geographical area; where people reside; buildings; institutions and the size of the community); sense of belonging and the attempt to improve the community for its members. By valuing the perspectives of pre-adolescent girls, a deepened understanding of the broad range of key informants (Dinner staff, Doctors and dentists, Head teachers, Girl Guide leaders, Government, Grandparents, Neighbours, Parents, Peer group, School cooks, Shop keepers, Siblings, Sports Coaches and Teachers) acting on their health behaviours was achieved (Objective 2). The community readiness score relating to healthy eating and drinking corresponded to the Preparation Stage (Objective 3), whereby influential community members have begun planning efforts by deciding what to do and who will do it and the community offers modest support of efforts promoting healthy dietary behaviours. The community readiness score for physical activity was higher corresponding to the Initiation Stage where there is enough information available to justify efforts and activities are underway to support healthy physical activity behaviours. Qualitatively, the key findings from applying the CRM are that: the effectiveness of community initiatives promoting healthy behaviours can be improved; there are varying levels of concern and awareness regarding unhealthy behaviours and child weight status in the community; social disparities are perceived to exist in community health behaviours; communication between schools and parents are seen as important for the success of school policies; parental attitudes and behaviours inform child behaviours; enjoyment is an important predictor of girls activity levels and aspects of the Charnwood Borough s environment do not support healthy behaviours. The CRM was shown to be an appropriate tool for assessing community readiness (Objective 4) providing the qualitative strengths of the model are emphasised. The community readiness score and the qualitative analysis informed the recommendations for an intervention in the Charnwood Borough (Objective 5). Key aspects of these recommendations include: raising the community s awareness of pre-adolescent girls health behaviours; ensuring all initiatives are accessible and appealing to low income families by working directly with these groups; fostering a greater sense of community through increased community cohesion and social interaction; placing social interaction and enjoyment at the centre of all activities, and attempting to make the healthier option the easier choice through modifications to the environment. Conclusions This thesis is the first to apply the Community Readiness Model to the prevention of overweight and obesity in pre-adolescent girls in the UK and has demonstrated the value of applying a community readiness assessment prior to the implementation of interventions.