Building Culturally Centered System Dynamics Logic Models for the Brown Buttabean Motivation Organization: Protocol for a Systems Science Approach.

BACKGROUND: Brown Buttabean Motivation (BBM) is an organization providing support for Pacific people and Indigenous Maori to manage their weight, mainly through community-based exercise sessions and social support. It was started by DL, a man of Samoan and Maori descent, following his personal weight loss journey from a peak weight of 210 kg to less than half that amount. DL is a charismatic leader with a high media profile who is successful in soliciting donations from corporations in money and kindness. Over time, BBM's activities have evolved to include healthy eating, food parcel provision, and other components of healthy living. A co-design team of university researchers and BBM staff are evaluating various components of the program and organization. OBJECTIVE: The purpose of this study is to build culturally centered system dynamics logic models to serve as the agreed theories of change for BBM and provide a basis for its ongoing effectiveness, sustainability, and continuous quality improvements. METHODS: A systems science approach will clarify the purpose of BBM and identify the systemic processes needed to effectively and sustainably achieve the study's purpose. Cognitive mapping interviews with key stakeholders will produce maps of their conceptions of BBM's goals and related cause-and-effect processes. The themes arising from the analysis of these maps will provide the initial indicators of change to inform the questions for 2 series of group model building workshops. In these workshops, 2 groups (BBM staff and BBM members) will build qualitative systems models (casual loop diagrams), identifying feedback loops in the structures and processes of the BBM system that will enhance the program's effectiveness, sustainability, and quality improvement. The Pacific and Maori team members will ensure that workshop content, processes, and outputs are grounded in cultural approaches appropriate for the BBM community, with several Pacific and Maori frameworks informing the methods. These include the Samoan fa'afaletui research framework, which requires different perspectives to be woven together to create new knowledge, and kaupapa Maori-aligned research approaches, which create a culturally safe space to conduct research by, with, and for Maori. The Pacific fonofale and Maori te whare tapa wha holistic frameworks for interpreting people's dimensions of health and well-being will also inform this study. RESULTS: Systems logic models will inform BBM's future developments as a sustainable organization and support its growth and development beyond its high dependence on DL's charismatic leadership. CONCLUSIONS: This study will adopt a novel and innovative approach to co-designing culturally centered system dynamics logic models for BBM by using systems science methods embedded within Pacific and Maori worldviews and weaving together a number of frameworks and methodologies. These will form the theories of change to enhance BBM's effectiveness, sustainability, and continuous improvement. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN 12621-00093-1875; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382320. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/44229.

Process evaluation of in-person, news and social media engagement of a community-based programme Brown Buttabean Motivation (BBM): a research protocol.

INTRODUCTION: The community group Brown Buttabean Motivation (BBM) initially began to assist Auckland Pasifika and Maori to manage weight problems, predominantly through community-based exercise sessions and social support. BBM's activities expanded over time to include many other components of healthy living in response to community need. With advent of the COVID-19 pandemic, BBM outreach grew to include a foodbank distributing an increasing amount of donated healthy food to families in need, a community kitchen and influenza and COVID-19 vaccine drives. A strong social media presence has served as the main means of communication with the BBM community as well as use of traditional news media (written, radio, television) to further engage with vulnerable members of the community. METHODS AND ANALYSIS: The study aims to conduct mixed method process evaluation of BBM's community engagement through in-person, social and news media outreach activities with respect to the health and well-being of Pasifika and Maori over time. The project is informed by theoretical constructs including Pacific Fa'afaletui and Fonofale and Maori Te Whare Tapa Wha Maori research frameworks and principles of Kaupapa Maori. It is further framed using the concept of community-driven diffusion of knowledge and engagement through social networks. Data sources include in-person community engagement databases, social and news media outreach data from archived documents and online resources. Empirical data will undergo longitudinal and time series statistical analyses. Qualitative text thematic analyses will be conducted using the software NVivo, Leximancer and AntConc. Image and video visual data will be randomly sampled from two social media platforms. The social media dataset contains almost 8000 visual artefacts. ETHICS AND DISSEMINATION: Ethics approval obtained from University of Auckland Human Participants Ethics Committee UAHPEC 23456. Findings will be published in peer-reviewed publications, disseminated through community meetings and conferences and via BBM social network platforms. TRIAL REGISTRATION NUMBER: ACTRN 12621 00093 1875.

Barriers to older Pacific peoples’ participation in the health-care system in Aotearoa New Zealand.

Introduction Participation in the health-care system is a key component of healthy ageing strategies. The number of Pacific people aged ≥65 years in Aotearoa New Zealand will increase significantly over the next decade. Addressing the considerable health inequities and unmet need for care Pacific Island people experience when compared to other ethnicities in Aotearoa New Zealand should be a priority. Aim To identify barriers to older Pacific people's participation in the health-care system in Aotearoa New Zealand. Methods A participatory action research design was utilised. In total, 104 Pacific co-researchers contributed to focus groups using Talanoa , a traditional method of conversational dialogue deeply rooted in Pacific Island culture. Data were collected in Pacific Island languages from storytelling and conversations shared within the focus groups. Data were translated into English and analysed using a collaborative approach. Results Three main themes captured older Pacific peoples' barriers to participation in the health-care system: accessing health care; relationships with health-care providers; and understanding the health-care system. Discussion Older Pacific people have the capacity to influence locally driven programmes to be more responsive to their needs and aspirations. Improving older Pacific peoples' participation in health care will require a commitment to partnership and inter-sectoral collaboration identified in recent ageing strategies. The findings will inform local communities, and policy and practice aimed at improving the health and wellbeing of Pacific peoples who are ageing in Aotearoa New Zealand.

Study protocol for evaluating Brown Buttabean Motivation (BBM): a community-based, Pacific-driven approach to health.

BACKGROUND: Buttabean Motivation (BBM) is a Pacific-led organisation which aims to reduce obesity amongst Pacific and Maori people in New Zealand enabling them to choose a healthy and active life-style for the duration of their lives, their children, their wider family and the community. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical role in nutrition and physical activity patterns. This study aims to evaluate the effectiveness of BBM for sustained health and wellbeing outcomes among its predominantly Pacific and Maori participants for both general BBM members and those with morbid obesity attending the 'From the Couch' programme. METHODS: Quasi-experimental pre-post quantitative cohort study design with measured or self-reported weight at various time intervals for both cohorts. Weight will be analysed with general linear mixed model for repeated measures, and compared with a prediction model generated from the literature using a mixed method meta-analysis. The secondary outcome is change in pre- and post scores of Maori scale of health and well-being, Hua Oranga. DISCUSSION: Multiple studies have shown that many diet and physical activity programmes can create short-term weight loss. The fundamental question is whether BBM members maintain weight loss over time. In New Zealand, Pacific and Maori engagement in health enhancing programmes remains an important strategy for achieving better health and wellbeing outcomes, and quality of life. Internationally, the collectivist cultures of indigenous and migrant and minority populations, living within dominant individualist western ideologies, have much greater burdens of obesity. If BBM members demonstrate sustained weight loss, this culturally informed community-based approach could benefit to other indigenous and migrant populations. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12621000931875 (BBM general members) First submitted 10 May 2021, registration completed 15 July 2021. ACTRN12621001676808 7 (From the Couch) First submitted 28 October 2021, registration completed 7 December 2021.

Understanding engagement with Brown Buttabean Motivation, an Auckland grassroots, Pacific-led holistic health programme: a qualitative study.

OBJECTIVES: The aim was to understand how participants engage with Brown Buttabean Motivation (BBM) a grassroots, Pacific-led holistic health programme and the meaning it has in their lives. The objectives were to explore the impact BBM had on all aspects of their health and well-being, what attracted them, why they stayed, identify possible enablers and barriers to engagement, and understand impact of COVID-19 restrictions. DESIGN: Qualitative study with thematic analysis of semi-structured interviews of BBM participants, followed by theoretical deductive analysis of coded data guided by Pacific Fonofale and Maori Te Whare Tapa Wha health models. In this meeting-house metaphor, floor is family, roof is culture, house-posts represent physical, mental, spiritual and sociodemographic health and well-being, with surroundings of environment, time and context. SETTING: Interviews of BBM members conducted in South Auckland, New Zealand, 2020. PARTICIPANTS: 22 interviewees (50% female) aged 24-60 years of mixed Pacific and Maori ethnicities with a mixture of regular members, attendees of the programme for those morbidly obese and trainers. RESULTS: Two researchers independently coded data with adjudication and kappa=0.61 between coders. Participants identified the interactive holistic nature of health and well-being. As well as physical, mental and spiritual benefits, BBM helped many reconnect with both their family and their culture. CONCLUSIONS: BBM's primary aim is weight-loss motivation. Many weight loss studies provide programmes to improve physical exercise and nutrition, but seldom address sustainability and other core factors such as mental health. Programmes are often designed by researchers or authorities. BBM is a community-embedded intervention, with no reliance external authorities for its ongoing implementation. It addresses many factors impacting participants' lives and social determinants of health as well as its core business of exercise and diet change. Our results indicate that BBM's holistic approach and responsiveness to perceived community needs may contribute to its sustained success.

The Importance of Pedestrian Network Connectivity for Adolescent Health: A Cross-sectional Examination of Associations between Neighbourhood Built Environments and Metabolic Health in the Pacific Islands Families Birth Cohort Study.

The research aim was to investigate associations between objectively-assessed built environment attributes and metabolic risk in adolescents of Pacific Islands ethnicity, and to consider the possible mediating effect of physical activity and sedentary time. Youth (n = 204) undertook a suite of physical assessments including body composition, blood sampling, and blood pressure measurements, and seven day accelerometry. Objective measures of the neighbourhood built environment were generated around individual addresses. Logistic regression and linear modelling were used to assess associations between environment measures and metabolic health, accounting for physical activity behaviours. Higher pedestrian connectivity was associated with an increase in the chance of having any International Diabetes Federation metabolic risk factors for males only. Pedestrian connectivity was related to fat free mass in males in unadjusted analyses only. This study provides evidence for the importance of pedestrian network connectivity for health in adolescent males. Future research is required to expand the limited evidence in neighbourhood environments and adolescent metabolic health.

Pacific Islands Families Study: Physical growth to age 14 and metabolic risk.

BACKGROUND: The relationships between the trajectories of weight gain from early childhood to adolescence and risk for metabolic disease are not well understood. OBJECTIVE: The objective of the study is to examine the relationships between weight gain from 2 to 14 years and metabolic risk factors at age 14 years in Pacific Island children. METHODS: z scores for weight were calculated at each of the ages 2.5, 4, 6, 9, 11, and 13.5 years in 1053 children. Growth trajectories were determined by estimating the linear trend of z scores with age for each child. In a subgroup of 204 children, biomarkers of metabolic risk were measured and related to linear trend intercepts and slopes. RESULTS: More rapid growth (greater slope of z score trajectory) was associated with higher concentrations of insulin, leptin (boys), urate, and markers of liver function, insulin resistance and inflammation. Children with higher weights in early life (greater intercept) showed fewer associations with metabolic markers, but considered together, intercept and slope were independently associated with a range of metabolic risk factors. CONCLUSIONS: Both rapid weight gain and a higher body weight in early childhood were associated with higher risk for metabolic disease. Monitoring growth trajectories may help target interventions to optimize nutrition, physical activity, and growth.

Vegetables: New Zealand Children Are Not Eating Enough.

We know that eating a variety of vegetables every day is associated with favorable health across the lifecourse. Internationally, food-based dietary guidelines encourage the consumption of a variety of vegetables and fruit but globally,people are not eating enough vegetables to meet the three-or-more-a-day guideline. Vegetables are good sources of vitamins and minerals, fiber, and many bioactive compounds that promote health and provide energy. They also help reduce hidden hunger (micronutrient deficiencies) and support the healthy growth and development of children. New Zealand is a world leader in the production of diverse nutrients and foods yet poverty and other environmental barriers mean only one in two children eats three-or-more servings of vegetables a day. Price and availability are limiting factors. The proliferation of community, school and home vegetable gardens and vegetable cooperatives may improve access. On a macro level, upstream policies such as a "living wage," affordable housing, and land-use planning are required. International dietary solutions include an agricultural shift to intensified horticulture with a focus on vegetables. The consumption of more plant-based foods including vegetables would reduce green-house gases, reduce land clearing, and help prevent diet-related disease if consumed daily across the lifecourse.

Accelerometer data treatment for adolescents: Fitting a piece of the puzzle.

This study aimed to assess the differences in participant retention and associations between physical activity and key variables when a range of accelerometer data inclusion criteria are employed. Data were drawn from 204 adolescents of Pacific Island heritage (survey, body composition, 7-day accelerometry) and their parents (date of birth, socioeconomic status) between October 2014 and February 2016 in Auckland, New Zealand. Data wear time criteria for inclusion were as follows: A) > = 10 h/weekday or > = 8 h weekend day, > = 5 days (at least one weekend day); B) > = 10 h/weekday or > = 8 h weekend day, > = 4 days; C) > = 7 h/day, > = 3 days; D) > = 10 h/day, > = 1 day. Overall, 49%, 62%, 88%, and 96% of participants met the criteria, respectively. Adjusted odds of meeting each criterion were examined using a multivariable logistic regression model. Almost 50% of participants were excluded by the most stringent inclusion criteria. Increased body fat percentage and proportion of time in moderate-to-vigorous activity were associated with decreased odds of meeting Criterions A and B. This research contributes to a growing understanding of the impact of differing accelerometer reduction approaches to sample retention and bias in adolescent physical activity research.

Tracking food consumption frequency of children from age 4 to 6 years: the Pacific Islands Families study.

AIM: To report longitudinal food frequency consumption and evaluate tracking of food frequency among a cohort of New Zealand-born Pacific children. OBJECTIVE: Identify the most commonly consumed foods and estimate tracking among Pacific children aged 4 and 6 years. METHOD: A qualitative food frequency questionnaire was administered to n>1,000 caregivers of children aged 4 and 6 years. Consumption scores were developed from averaged frequency of daily food. Foods and food groups were examined for tracking. RESULTS: Caregivers completed questionnaires for 646 children at both ages. Twelve most frequently consumed foods were identified, accounting for up to 25% of all food consumed daily. Across ages 4 and 6, the association for frequency of the most frequently consumed foods was moderate (r(2)=0.53). Food groups: breads and cereals; meat and alternates; and vegetables and fruit constituted approximately 72% of all foods consumed daily. The association of frequency of consumption within food groups across the two measurement periods was strong (r(2)=0.96). CONCLUSIONS: Pacific children consume similar foods that track from age 4 through age 6 years.

Maternal Cultural Orientation and Child Growth in New Zealand Pacific Families.

BACKGROUND: In New Zealand (NZ), children of Pacific heritage are generally born heavier and gain weight more quickly than non-Pacific children. Immigrants' health is commonly expected to converge with the host population through acculturation. The aim of this analysis was to examine whether mothers' acculturation is associated with less-rapid weight gain in NZ Pacific children, and whether this differs by mothers' nativity. METHODS: In a birth cohort of 1249 children followed 2000-2011, birth weight and weight and standing height, measured at years 2, 4, 6, 9, and 11, were quantified as sex- and age-specific weight (weight-for-age; WFA) and BMI z-scores. Maternal acculturation (range, 11-54) was assessed at baseline and years 4, 6, and 11. RESULTS: In adjusted models using generalized estimating equations to account for repeated measures, maternal acculturation was not significantly associated with children's WFA or BMI z-scores overall. In stratified analyses, change in maternal acculturation score was inversely associated with WFA z-score change among children of NZ-born, but not immigrant, mothers (beta=-0.021; 95% confidence interval, -0.036 to -0.007; p=0.006; interaction, p=0.005). CONCLUSIONS: Our study provides the first evidence in a longitudinal sample that changes in maternal acculturation can influence children's growth, suggesting the importance of lifestyle or behavioral factors related to a mother's cultural orientation. Given the high risk of obesity and its related conditions in the NZ Pacific population, critical next steps are to identify mediating factors, as well as to understand the processes influencing growth among children of immigrant mothers.

Pathways to health and wellbeing for Pacific children--how are we tracking?

The government's 5-year strategy for improving Pacific people's health and wellbeing, 'Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010-2014, emphasised disease prevention and improvements in health systems as priority outcomes. Actions that would contribute to disease prevention included reducing barriers to health in structural mechanisms (such as better access to healthy housing) and improving health service systems. However, after 4 years since its release, not only have important structural barriers remained but so have the poor health outcomes of Pacific peoples in New Zealand.

Growth centiles of Pacific children living in Auckland, New Zealand.

BACKGROUND: Since 2000, the longitudinal Pacific Island Families study has measured the weight, height and body mass index (BMI) of 582 girls and 643 boys at 2, 4, 6 and 9 year data collection phases. AIM: To extend and record the age-related distribution of weight, height and BMI measures in Pacific children aged 2-10 years and to compare the distribution to population and clinical growth charts. METHODS: Gender-specific age-related centile curves were derived using the LMS method for weight, height and BMI. The 50th centiles from the World Health Organisation growth reference for 2-5 year olds and the Centres for Disease Control (CDC) for 5-10 year olds were compared. Overweight and obesity were defined by the CDC BMI 85th and 95th centiles. RESULTS: The proportion of children whose weight and height were above the reference 50th centile increased with age. At age 10, using CDC criteria, more than 50% of the children were classified as obese and 70% were overweight. CONCLUSIONS: These charts support the need to prioritize interventions for Pacific families to address childhood obesity. These centile curves could help assess the relative growth of Pacific children and identify children for further assessment and treatment.

Parental perceptions of their child's weight and future concern: the Pacific Islands Families Study.

AIM: Little is known about the perception of overweight, expressed as a level of concern, of Pacific parents and its relevance to children's weight. The aim of this study was to analyse data collected at birth and four and six years in the Pacific Island Families Study (PIFS) to investigate the relationship between parental perceptions of child weight status and actual weight status. METHOD: A total of 569 parent child dyads (299 boys (52.5%), 270 girls (47.5%); 47.1% Samoan, 20.9% Tongan, 18.6% Cook Island, 4.9% Niue, 8.4% other Pacific) were examined in this Parental Perception of Overweight Obesity Study (PPOS). At four and six years the question was asked of the parent "How concerned are you about your child becoming overweight?" A 5-point Likert scale was used, with possible answers ranging from "unconcerned" through increasing levels of concern to "very concerned". At four and six years weight and height were also measured and body mass index (BMI) derived and classified using international standards. Potential factors associated with parental perception were examined in a multivariate model using logistic regression. RESULTS: The majority of parents were unconcerned at four and six years (62% and 69.1%) about the future overweight status of their child. Using the international BMI classifications, at four years 40.1% of the children were classified as normal weight, 34.1% as overweight, and 25.8% as obese. At six years the proportions were similar; i.e., normal 41.3%, overweight 31.1%, and obese 27.6%. At four and six years the proportion of parents who were concerned about their child's future weight status was related to the child weight status e.g., at 6 years 20% of parents of normal children, 28% percent of parents of overweight and 51% of parents of obese children were concerned (p trend < 0.0001). Ethnicity and parity were significantly related to parental perceptions (p < 0.0001); identification with Tongan ethnicity was related to a higher proportion of concerned parents and an increased number of children in the family were related to a smaller proportion of concerned parents. DISCUSSION: While the level of concern was low and the prevalence of overweight and obesity high, the context of the socio economic and demographic environments must be taken into account in the formulation of interventions. Overweight and obese Pacific children may benefit from interventions that target the awareness of parents, making them more conscious of the relationship of obesity with food and activity patterns and give practical support to change the environment. These findings raise the concern that there is a normalisation of overweight and obesity in Pacific parents and/or children. Interventions firstly should address the socio economic demographic environment of a Pacific family making healthier choices the easier choices.

Ten years of research for the Pacific Islands Families Study: a comparative review of publications.

In 2000, the Pacific Islands Families Study (PIFS) initiated research into developmental pathways of health outcomes for Pacific children and families. Not only was the study premised on addressing the gap in longitudinal research of Pacific peoples, it also aimed to increase Pacific-researcher capacity. After ten years of operation, this paper reviews the journal publications and Pacific authorship from the PIFS. The PIFS team published 55 journal articles in 29 peer reviewed journals. Forty-four (80.0%) of these articles had a Pacific author, including seven (12.7%) where the first-author was Pacific. Most articles used cross-sectional data (n = 38, 69.1%) and a quarter used longitudinal data (n = 15, 27.3%). Eighteen (62.1%) of the 29 journals that PIFS articles were published in were registered on the Journal Citations Report database, with 2009 5-year journal impact factors ranging from 1.064 to 6.504. The PIFS achieved a similar number of publications compared with the Dunedin Multidisciplinary Health and Development Study (DMHDS, n = 48) and Christchurch Health and Development Study (CHDS, n = 67). Further analysis, showed that the PIFS (27.3%) had the lowest proportion of publications using longitudinal data compared to the DMHDS (n = 37.5%) and CHDS (65.7%). This review provides a stocktake of publications in the first decade of the PIFS and shows that although the development of Pacific-researcher capacity has been promising, greater attention must be given to increasing first-authorship of academic writing and to utilising longitudinal data to better understand the origins of health status of Pacific peoples.