Using evidence in health promotion in local government: contextual realities and opportunities.

ISSUE ADDRESSED: New national and state preventive health investments have provided significant funding for local governments (LGs) to be involved in planning and implementing health promotion interventions. There is an expectation that this work is evidence based; however, inadequate support and systems exist for evidence-informed planning and decision making in LGs. Previous initiatives have aimed to build capacity and leadership in LG health promotion, but the training, support and infrastructure have been sporadic. METHODS: Across 2009-11 we implemented a National Health and Medical Research Council of Australia (NHMRC)-funded university-LG research project to explore the feasibility, usefulness and outcomes of a knowledge translation (KT) intervention to increase the use of evidence in LGs. Within this exploratory cluster randomised controlled trial, one strategy being evaluated was workforce capacity building, during which group discussions revealed contextual challenges in delivering evidence-informed health promotion within the current funding context. Discussion was recorded. The group acknowledged the need to identify barriers and realistic practical solutions, and to communicate these more broadly. RESULTS: Barriers to sourcing and applying evidence to inform health promotion emerged from discussions with LG representatives. System-level contextual factors affecting decisions were also discussed, namely concerns about organisational capacity and 'culture' to plan, implement and evaluate effective initiatives in LGs. Possible solutions suggested included: systems for access to academic literature; processes that make it easier to use evidence; training in evidence-informed health promotion to build organisational culture and capacity; and research-practice partnerships and mentoring. CONCLUSIONS: Targeted strategies with individuals (LG staff) and organisations (leadership, systems) are needed to realise the potential of current health promotion investments. Research-practice partnerships are likely to be important. It seems obvious that it is impossible to be evidence informed without mechanisms to access and apply evidence. We invite other LGs to reflect upon their experiences in such initiatives, and to consider whether the strategies we propose may be useful. So what? The increased emphasis on health promotion and non-communicable disease prevention programs may be limited by the capacity, confidence and organisational culture to inform policies and programs with best-available evidence. We describe some of the current challenges and contextual factors as they are being experienced. There are opportunities for national and state governments, organisations representing local government (e.g. municipal associations) and research partners to provide targeted support to councils. This may assist in achieving effective health promotion at the community level.

Changes in Primary School Children's Behaviour, Knowledge, Attitudes, and Environments Related to Nutrition and Physical Activity.

Rigorous evaluation of large-scale community-based obesity interventions can provide important guidance to policy and decision makers. The eat well be active (ewba) Community Programs, a five-year multilevel, multistrategy community-based obesity intervention targeting children in a range of settings, was delivered in two communities. A comprehensive mixed-methods evaluation using a quasiexperimental design with nonmatched comparison communities was undertaken. This paper describes the changes in primary school children's attitudes, behaviours, knowledge, and environments associated with healthy eating and physical activity, based on data from six questionnaires completed pre- and postintervention by students, parents, and school representatives. As self-reported by students in years from five to seven there were few significant improvements over time in healthy eating and physical activity behaviours, attitudes, knowledge, and perceived environments, and there were few changes in the home environment (parent report). Overall there were considerably more improvements in intervention compared with comparison schools affecting all environmental areas, namely, policy, physical, financial, and sociocultural, in addition to improvements in teacher skill and knowledge. These improvements in children's learning environments are important and likely to be sustainable as they reflect a change of school culture. More sensitive evaluation tools may detect behaviour changes.