Academic journal article Canadian Journal of Public Health

Creating a Collective Impact on Childhood Obesity: Lessons from the SCOPE Initiative

Academic journal article Canadian Journal of Public Health

Creating a Collective Impact on Childhood Obesity: Lessons from the SCOPE Initiative

Article excerpt

Rising rates of obesity are driving the increasing burden of diseases such as type 2 diabetes, cardiovascular disease1 and cancer.2 Obesity and overweight during childhood are especially concerning given the longer duration of exposure to unhealthy lifestyles, and because many obese children become obese adults.3 Childhood obesity is a complex large-scale social problem caused by a multitude of interdependent factors:4 Children and families do not live and function in isolation but rather in the context of their family environments, neighbourhoods and communities. Addressing childhood obesity requires collective action across multiple stakeholder groups,5 where emergent solutions allow for continual adaptation in an ever-changing environment.

Community-based participatory research (CBPR) is a collaborative, co-learning and community-partnered approach to addressing complex social problems.6 In the literature, best practice principles for community-based obesity prevention advise on community engagement, program design and planning, evaluation, implementation and sustainability, and governance.7 Evidence supports the use of CBPR in solving childhood obesity: EPODE (Ensemble Prévenons l'Obésité Des Enfants),8 Shape Up Somerville (SUS),9,10 and Be Active Eat Well11,12 have all demonstrated significant and sustainable decreases in childhood obesity prevalence in quasi-experimental trials.13 In Canada, we have a rich tradition of applying CBPR to chronic disease prevention and health promotion.14-19 This experience has found that such collaborative, capacity-building initiatives are very challenging to evaluate because of their dynamic and evolving nature over time across sectors and levels.20

SCOPE (Sustainable Childhood Obesity Prevention through Community Engagement) is a CBPR childhood obesity prevention initiative currently being implemented in British Columbia (BC). SCOPE builds on existing successful CBPR childhood obesity initiatives8-12 and explores the translation of this CBPR approach into the Canadian context. In this paper, we describe the SCOPE experience using process evaluation data, framing the discussion within the Collective Impact (CI) model.21

CI is a 'long-term commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem.'21 CI embraces CBPR principles and is governed by five key conditions:

1. A common agenda where participating organizations have a shared vision for change which includes a mutual understanding of the problem and a collective approach to solving it.

2. Mutually reinforcing activities across a diverse group of organizations representing multiple sectors where participants implement various, often separate, actions that are coordinated and supported through a reinforced plan of action.

3. Continuous communication among stakeholder groups to build trust and provide opportunities for the exchange of knowledge and expertise, and collective problem solving.

4. A backbone support organization with staff who handle the administrative and logistical details associated with coordinating multiple organizations using adaptive leadership, facilitation, technology and communications support.

5. A shared measurement system where there is agreement on how success of the initiative will be measured and reported.

Participants and setting

SCOPE partners with local stakeholders from multiple sectors to influence environments in which children live, learn and play so that the healthy choice is the easy choice for children and families. The SCOPE team approaches, or is approached by, local government or a local organization to secure their interest in participating in an evidence-based CBPR approach to childhood obesity prevention. Once endorsed, a SCOPE coordinator is hired and this person is responsible for leading community engagement activities while liaising with a central SCOPE team located at British Columbia Children's Hospital (BCCH) in Vancouver, BC. …

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