This part of our research program will explore factors in the less advantaged socioeconomic environment that predispose childhood obesity in Sweden and across Europe Even in a relatively egalitarian society like Sweden, inequalities impede progress not only in promoting healthy lifestyles, but also in conducting population-based research, a situation that is related in part to challenges of recruiting study populations. Thus, this study will involve the research problem of low participation rates in socioeconomically deprived and minority study populations, which often suffer from high obesity rates. The project addresses the problem using the approach Participatory research, designed to encourage commitment, active participation and influence of community members.
Health Equilibrium Initiative (HEI), a community based health intervention, drawing on Community based participatory research (CBPR), generates data that enables evaluation, steering and research. HEI aims at narrowing the health gap, primarily by supporting a healthy lifestyle in children. CBPR has a potential both to engage individuals and groups with low SES both as study participants and to diminish inequity in health. HEI has, in an earlier stage, been conducted as a natural experiment (i.e. without control groups) in an underserved area, results showing favorable effects on children’s food habits and weight development..In the current project, the assessment of the implementation of the program (process evaluation) will include document analysis (structured reports from meetings and dialogues, school/workplaces policies and curriculum, food service menus); key informant interviews and focus groups (parents, children, professionals).
We conducted focus groups interviews with high school students from areas of low socioeconomic status (SES). Open-ended discussions aiming to shed light on topics such as self-efficacy - what it means for a teenager to believe one can affect one’s own health, the meaning that the youths attach to the concept of health and the sometimes risky health-related behaviors that may be an integral part of their lifetime health experience. Their ideas about how to optimize participation, including how they and their peers should be approached by investigators, how invitation letters should be formulated and sent, which questions are appropriate to ask and how they should be phrased, have also been addressed. Participants have been asked to give feedback on the instruments that have been used in our other studies, e.g. the paper-based questionnaire used in the Grow-up study. Finally we have explored what adolescents would like to receive in return for participating in such a survey and, if so, identify an appropriate form of material and/or non-material compensation.
The project includes an evaluation to assess the health economic impact of the intervention. For this purpose, 175 children in their first school year (age 7 y) from intervention areas and 175 from control areas are invited to 1) anthropometric examination (weight, height, body composition and waist), 2) short interviews about food pattern, physical activity and belief in their ability to affect health.. 3) Learning, memory and risk-taking are personal traits with a potential impact on health. These aspects are being assessed by the computer-based CANTAB tests. The examinations will be repeated after two years and form the base of a health economic analysis. In this longitudinal part of the study, growth charts from CHC will be used to get additional data on weight and height.
Maria Magnusson, PhD, project leader, and Moa Hallmyr-Lewis
Department of Public Health and Community Medicine, Section for Epidemiology and Social medicine
Maria Magnusson, 46 31-786 6118