The Healthy Children, Healthy Weights toolbox (HCHWTB) project aims to address childhood overweight in Columbus through a coordinated, evidence-based approach. HCHWTBs are designed to develop weight management competence in our youngest children as they develop and adults who care for them, specifically parents, childcare providers, the faith-based community and healthcare providers. A total of 411 people have participated in the project to this point.
Toolbox materials address issues that, according to research, are key to addressing childhood weight management. These have been condensed into five focus areas and packaged into key messages. The key messages are the same for each audience, however program implementation strategies vary.
The components to promote a healthy weight in the 0-5 age group include: developing self-esteem and positive body image, assessing weight appropriately, increasing developmentally appropriate physical activity and limiting television viewing, developing healthy nutrition and eating behaviors, and promoting positive drink choices and breastfeeding.
Childhood overweight has increased dramatically both nationally and locally, and has emerged as a critical community priority. The Community Health Risk Assessments conducted in 2000 and 2002 in Franklin County identified a significant increase in prevalence of childhood overweight. This increase has presented an urgent challenge to develop a strong, evidence-based and meaningful process to address childhood weight management. Current interventions to promote healthy weights generally focus on school age children and adults. Research studies, however, show that children establish eating patterns and body image by the age of five; thus, programs to promote healthy weight should begin during infancy and provide resources for parents early. Tools to help educate parents of children 0-5 and others about appropriate, evidence-based strategies to manage weight at this stage are largely unavailable.
The HCHW Project is designed to foster systems changes by creating a competent cohort of community members, health care professionals and others, with regard to weight management. For adults, competency includes increased knowledge of concepts related to weight management, developmentally appropriate nutrition, feeding practices and physical activity. For children, it includes the development of positive self-image, the ability to make appropriate food choices, adoption of healthy eating behaviors and engaging in adequate physical activity. Young children will have an increased level of physical activity and a healthier diet. Clinicians will be empowered to provide appropriate guidance and tools to enable their patients to develop adequate levels of physical activity and sound dietary practices. Finally, multiple settings will be working in concert to develop environments that promote physical activity and healthier eating behaviors.
The goal of the HCHW toolbox is to provide focused messages related to promoting a healthy weight in young children, along with practical strategies that may be used in multiple settings. Toolbox materials address issues that, according to research, are key to addressing childhood weight management, including growth and development, healthy eating behaviors, nutrition, development of positive body image, and developmentally appropriate physical activity. Tools include information sheets, activity plans, resource lists, placemats, games, posters and, for clinicians, a set of masters for patient education materials. An emphasis was placed on making materials easy to understand (at or below the sixth grade reading level).
Agency Community RolesIn order to develop a focused community-wide approach to address childhood overweight, Columbus Health Department (CHD) invited organizations that work with young children to collaborate on developing coordinated strategies and solutions. This invitation led to the creation of the Partnership to Address Childhood Overweight (PACO) that decided on a vision to decrease the prevalence of childhood overweight in the Columbus community.
PACO worked together with the Columbus Health Department (CHD) to develop the Healthy Children, Healthy Weight Initiative and it's first project, the Healthy Children, Healthy Weight Toolbox (HCHWTB).PACO has included several key partners. Columbus Children's Hospital has assisted in the development of the clinician toolbox and has helped to promote its use in the Children's Hospital system. In addition to its' Primary Care Network, Children's Hospital also provides training in pediatrics for OSU medical school, which has one of the nation's largest pediatric residencies, and graduate medical education for pediatricians. The School of Physical Activity and Educational Services, in the College of Education at the Ohio State University assisted in the development of the toolbox and training, specifically related to developmentally appropriate physical activity. Action for Children and Children's Hunger Alliance, two key Columbus organizations responsible for childcare provider competency development, have provided guidance and linkage to childcare providers and their continuing education system. Participation from Franklin County's two primary Head Start organizations, Columbus Metropolitan Area Community Action Organization Head Start and Child Development Council of Franklin County, have also provided the project with crucial guidance and testing of project training and materials with Head Start teachers. FaithWorks, a coalition of 17 faith-based organizations whose mission is to create and maintain healthy communities through partnerships with providers of health services, has provided input related to working within the faith-based community. Additionally, other leaders for Columbus faith organizations have provided feedback and guidance to the project such as the Ohio Health Hospital System Parish Nurse Program and the Jewish Community Center.
Costs and ExpendituresThe costs associated with continuation of the HCHW Toolbox project are related to arranging and providing the training (staff time) and toolbox production. Currently, a 1.0 FTE dietitian manages the project, recruits participants and arranges training. In addition, the project contracts with a student dietitian to conduct evening and weekend training as needed. Material costs for training initially include plastic food models and other educational display items used in the presentation. Ongoing costs are low, including copies of participant workbooks ($0.65 per copy) and a few other selected handouts. Light refreshments are sometimes provided to parents when the training is part of an already scheduled event, which is provided by that organization.
Production of the toolboxes themselves include printing, binders, folders, and labels. This ranges from $13.50 to $34.50 per toolbox depending on the audience. In addition, some labor time is required for toolbox assembly. Costs for ongoing evaluation include one or two follow-up phone calls, two mailed surveys with return postage, and data entry.
Materials were initially tested with representatives from each of the four audiences to assess opinions about the tools' visual appeal, ease of comprehension, and usability. A follow-up phone survey was conducted in December 2003 to obtain that information.
A 2-month field-test allowed for participants to try the activities and strategies suggested in the toolbox, to provide feedback regarding strengths and weaknesses, and to recommend changes prior to a longer pilot test. A total of 232 participants from four settings were trained on principles of weight management and toolbox use. This took place between March and August 2004. At the time of the training, a pretest was conducted of participants' knowledge and attitudes related to training concepts, as well as a survey regarding the training itself. A post-test of knowledge and attitudes and a survey of toolbox use were conducted 2 months post training by mail or phone.
The goals of Phase 3, currently underway, are to measure short-term changes in specific behavior of toolbox users. Toolbox use, as well as change in knowledge will also be evaluated. Through this 6-month pilot, participants attend a 1.5-hour training and receive a follow-up phone call at 3 months, as well as 2 follow-up surveys at 3 and 6 months. Staff are also available to participants by phone or email and provide additional support to organizations when requested. A total of 164 participants are involved in the pilot, which will conclude in July 2005.
Additionally, a marketing campaign of select project messages is being developed for testing in prioritized neighborhoods. This strategy will have a multi-layered approach that builds on current processes to improve dissemination and penetration of messages for this audience and thus reinforce key concepts related to promoting healthy weight in children.
Various sources of funding have been utilized for this project. Columbus Health Department has provided staff time and resources to develop and produce the HCHW Toolboxes. CHD as the lead agency for PACO also obtained: $20,000 from the Healthy Columbus Advisory Council to produce toolboxes for the feld-test and launch the initiative; $20,000 from the Osteopathic Heritage Foundation to produce additional toolboxes, support limited training and evaluation efforts; and $65,000 in funding from the A. Irene Emswiler and Marjorie Wittwer funds of the Columbus Foundation to expand the project and add the social marketing campaign component.
Overall response and feedback by participants in the project has shown that adults who work with young children do want and need these tools. Response by participants has indicated some differences in how specific audiences should be recruited, trained and supported regarding toolbox use. The childcare and preschool teacher audiences seem to be the best ft for the current approach. Other audiences have shown interest in the project; however, alterations in our approach may greatly improve participation and effectiveness. Additionally, some smaller denominations of tools have been recommended for specific groups, such as for use in the faith-based setting.
Beyond the current funding sources, the organizations that form PACO are committed to sustaining efforts to address childhood overweight and the HCHW project by sharing and combining resources and seeking ongoing funding. The project has the potential to garner additional funding support from new grant sources after pilot testing is completed. Ongoing funding opportunities continue to be explored. Other organizations have indicated their willingness to purchase toolboxes. A variety of strategies are being explored to ensure not just toolbox dissemination, but also the training required to optimize use of the toolbox. A "train the trainer" approach is being explored for the project. Individuals who have been trained would become master trainers for their own institutions, reducing the personnel costs related to this component. This strategy will be promoted after the pilot has been completed.