This example demonstrates how public health team in a Leeds based charity have approached obesity prevention and management within disadvantaged communities. CHEs are recruited from disadvantaged communities and having undertaken 14 days of training, promote health through sessional work with HLNL. Potential CHEs are often parents who have attended sessions in the community or existing volunteers. They undertake community research, run events, support campaigns, deliver healthy cooking sessions, deliver physical activity sessions and other health improvement activities, and pass on information within the community; some go on to train other CHEs. This submission supports PH42 recommendation 3 which indicates that public health teams should identify and work with 'champions'. Recommendation 4 is about coordinating local action and highlights how working with population groups should be jointly planned.
Aims & Objectives
The Fit Together project aims to support 270 families over 3 years to reduce obesity in children - particularly new parents, families with children in preschool/reception class and families with children in years 6/7. Selected CHEs will be given additional training to work with families with the aims of:
1) Increasing positive attitudes towards food and a healthier lifestyle through gaining knowledge and supporting each other to make those small changes to reduce obesity levels.
2) Increasing self-esteem and confidence through involvement in passing health messages to others, giving and receiving support and volunteering for the project in their own community i.e. acting as mentors for other families.
3) Improving skills and knowledge about how to enjoy and make the most of their life through learning at training sessions and sharing their own skills within their communities.
4) Improving integration between existing services to provide a holistic family centred approach to support family health.
CHEs support different projects within HLNL each of which is based on evidence of need and is responsive to what communities identify as priorities. Fit Together came about in response to concerns about high levels of childhood obesity. In 2010-2011, Leeds gathered data from 95.5% of eligible children as part of the National Child Measurement Programme (NCMP) This percentage is higher than the national average and provides a good indication of obesity levels in Leeds. The key findings of the data collection were:
- 23.1% of reception aged children are overweight or obese (13.5% overweight, 9.6% obese). The national average is 22.6%
- 33.9% of Year 6 aged children are overweight or obese (14% overweight, 19.9% obese). The national average is 33.4%
These figures are especially shocking when compared with the number of children who are underweight: 0.7% in Reception, and 1.4% in Year 6, and formed the basis of a successful bid for funding for Fit Together.
Fit Together consists of courses run over 6 weeks in local venues that are easy for families to access. Several programmes will be provided in each area so that they can choose one that fits in most easily with their lifestyle. The programmes will be delivered by CHEs, with support from volunteers.
CHEs and volunteers are given additional training, specifically in weight management to enable them to confidently deliver Fit Together programmes in the community. Each family supported by CHEs will have very different individual needs, therefore CHEs are trained to support families in relation to their needs, rather than deliver a prescriptive programme. Families explore their own issues with support as a whole unit and plan who they need to speak with and involve as part of making lifestyle changes. CHEs help to link families to existing services within the community as part of the course. The programme is very flexible and adopts a process model of curriculum which ensures that the families desires are taken into account.
Courses explore all aspects of health including sharing skills and having a healthy lifestyle on a limited budget. A great strength of the courses is that they will be taught by people who live in the similar communities and/or have been in the same situation, so they can relate to learners.
A unique element of the programme is that families who are successful in changing their lifestyles will be invited to mentor new families enrolled on the programme. Mentor families will also be trained up by HLNL who will continue to support these families.
Results and evaluation
Fit Together programmes are 6 weeks long. Monitoring and evaluation focuses on the development of individuals and families, rather than clinical results i.e. reduction in BMI. Families set weekly goals and monitor their behaviour change, under the supervision of CHEs. Initial observations are that families are very happy to disclose areas that they would like to improve on to CHEs, and individuals admitted not being as truthful to health professionals for the fear of being 'told off'. In the first Fit Together New Families programme, pregnant ladies and new mums successfully made small changes to their lifestyles to improve health and wellbeing. A key focus of the course was the impact that parents can have as healthy role models, particularly healthy weight role models. Parents improved cooking skills, tried new healthy recipes and reduced high fat and high sugar snack and drink consumption. Parenting techniques were also addressed, particularly around feeding behaviours. One mum stopped cooking a different meal for her 3 year old son every evening and he has started to eat the family meal. Sleep routines were also improved.
Further Fit Together programmes will start in 2013, running in schools. Whilst weight measurements are not essential, families will be encouraged to be monitored, just like parents regularly monitor their child's height. This process is encouraged as self monitoring, and so the family receives feedback on the impact of their lifestyle changes, rather than doing it for the evaluation of the project.
Key learning points
- Tutors need to have current, face to face, experience of working in communities
- Training needs to be participatory and rooted in learners lived experience
- Prejudice (including of tutors) needs to be discussed and challenged
- Courses should be diverse and inclusive
- Use the plan-do-review model - building in evaluation from outset
- Keep jargon to a minimum and use accessible language
We used these 10 top tips for project success:
1. Little Community (not Big Society) means small intimate projects where everyone knows everyone and everyone becomes a 'family' which means we help each other.
2. Generosity within the project; the best of everything on the training course to demonstrate how positive we feel about our CHES teams.
3. Equality-all the training the project leaders go on is exactly the same as the CHES go on, provides a shared and flat common ground.
4. Project Leaders go out and about with CHESs and share the experience, building confidence to do outreach.
5. CHES choose the communities they work for and consequently do their best work; they learn who they do want to work with and who they don't.
6. Simple-all work systems stripped back to bare minimum for consistency and continuity and so that they can be easily communicated and replicated.
7. It's not about the money: We pay the CHES so, it's like a real job and to given the message that what they do is worth a paying for.
8. Say it when it's good- Say it when it's bad-honest, empathetic feedback & reflection as egoless as you can make. This means smile when you winning-celebrate the success and cry when you're losing-Acknowledge the irritation and anxiety when it's not working and move on.
9. Employ people for what they can do and not for an absence of weakness.
10. Lead by value (community) not by strategy.