Systems approaches to childhood obesity prevention: ground up experience of adaptation and real-world context.

OBJECTIVE
Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. Systems science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods, and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research specific terminology of scale-up, fidelity, adaptation, and context, drawing from community-based systems dynamics and our experience in designing, implementing, and evaluating non-linear, community-led systems approaches to childhood obesity prevention.


DESIGN
We acknowledge the importance of using a practice lens, rather than purely a research design lens and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens.


SETTING
Communities.


PARTICIPANTS
Practice-based researcher experience and perspectives.


RESULTS
Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regards to stakeholder involvement, capacity, boundary identification and co-creation of actions implemented to address childhood obesity will ensure scale up, fidelity, context and adaptation are embedded.


CONCLUSIONS
We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process, and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.