Process evaluation of a community-based adolescent obesity prevention project in Tonga.

BACKGROUND: The rising burden of obesity in Tonga is alarming. The promotion of healthy behaviours and environments requires immediate urgent action and a multi-sectoral approach. A three-year community based study titled the Ma'alahi Youth Project (MYP) conducted in Tonga from 2005-2008 aimed to increase the capacity of the whole community (schools, churches, parents and adolescents) to promote healthy eating and regular physical activity and to reduce the prevalence of overweight and obesity amongst youth and their families. This paper reflects on the process evaluation for MYP, against a set of Best Practice Principles for community-based obesity prevention. METHODS: MYP was managed by the Fiji School of Medicine. A team of five staff in Tonga were committed to planning, implementation and evaluation of a strategic plan, the key planks of which were developed during a two day community workshop. Intervention activities were delivered in villages, churches and schools, on the main island of Tongatapu. Process evaluation data covering the resource utilisation associated with all intervention activities were collected, and analysed by dose, frequency and reach for specific strategies. The action plan included three standard objectives around capacity building, social marketing and evaluation; four nutrition; two physical activity objectives; and one around championing key people as role models. RESULTS: While the interventions included a wide mix of activities straddling across all of these objectives and in both school and village settings, there was a major focus on the social marketing and physical activity objectives. The intervention reach, frequency and dose varied widely across all activities, and showed no consistent patterns. CONCLUSIONS: The adolescent obesity interventions implemented as part of the MYP program comprised a wide range of activities conducted in multiple settings, touched a broad spectrum of the population (wider than the target group), but the dose and frequency of activities were generally insufficient and not sustained. Also the project confirmed that, while the MYP resulted in increased community awareness of healthy behaviours, Tonga is still in its infancy in terms of conducting public health research and lacks research infrastructure and capacity.

Evidence for a curriculum review for secondary schools in Fiji.

This pilot study aimed to gather information about knowledge of and attitudes towards a range of health and dietary issues, with a focus on obesity and NCDs. It involved 967 children equally distributed between Form 3 (age range 13-14) and form 5 (age range 16-17) from three schools, one from each of the health divisions in Fiji. It was found that almost half of the sample group were of "normal" weight, whilst 18% were classified as "overweight" and 16% as "obese". Half the children took an inactive mode of transport (bus/car) to school and a higher percentage of those who went by bus/car were overweight. The average daily consumption of fruit and vegetables was very low and the consumption of fried foods was high, particularly in urban-based schools. The majority of students did not know the full and correct definition of "balanced meals". Despite the majority of children (83.7%) recognizing the importance of PA and 75% of children reporting that they exercised "for health", only 14% of boys and 10% of girls said they looked forward to PE classes as it was good for their health. Ninety percent of children indicated that being overweight is not healthy and that 75% of children think that being underweight is not healthy. Overall, the children recognized the importance of good diet and exercise for health. However, gaps existed in the curriculum--particularly regarding the importance of engaging in PE for health, the role of obesity in increasing the risks of NCDs and the specific meanings of terms such as "health" and "balanced meals". Modification of the curriculum to enforce knowledge of the importance of PE/PA and the way they impact upon health, may improve the dietary and PA trends seen in schools in Fiji.