Assessing community readiness to reduce consumption of sugary drinks in remote Aboriginal and Torres Strait Islander communities: A useful tool for evaluation and co-design.

ISSUE ADDRESSED: There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non-Indigenous practitioners culturally adapted and applied the Tri-Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness. METHODS: Aboriginal community-controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12-month follow-up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks. RESULTS: The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre-defined issue, time and resource-intensiveness of the process, and need to review appropriateness prior to implementation in other regions. CONCLUSION: The adapted CRT was valuable for evaluating the project and co-designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. SO WHAT?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns.

Adaptation and evaluation of a nutrition and physical activity program for early childhood education settings in Aboriginal and Torres Strait Islander communities in remote Far North Queensland.

ISSUE ADDRESSED: Good nutrition, physical activity and adequate sleep are essential for the healthy growth and development of young children. Due to complex cultural, historical, social factors, Aboriginal and Torres Strait Islander children face additional challenges to optimal health, particularly in remote areas of Australia. 'Learning, Eating, Active Play and Sleep' (LEAPS) was a Queensland-wide professional development program designed to support early childhood education and care (ECEC) educators to implement and reinforce healthy nutrition and physical activity in their services. This article describes the adaptation, implementation and evaluation of LEAPS for remote ECEC settings in Cape York. METHODS: An Aboriginal and Torres Strait Islander Reference Group was commissioned to provide advice about the appropriateness of the existing program for Aboriginal and Torres Strait Islander ECEC settings. Based on the advice of the Reference Group, the program was adapted for use in Cape York and was evaluated using the RE-AIM framework and a combination of data sources. Quantitative data provided information about changes to participant knowledge and confidence regarding nutrition and physical activity and in-depth interviews allowed further insights into enablers and challenges for successful program implementation. CONCLUSION: A tailored LEAPS program increased participants' knowledge and confidence regarding nutrition and physical activity in ECEC settings. The importance of community consultation, building relationships and face-to-face delivery of training were highlighted as key enablers. The evaluation identified a number of challenges relating to competing priorities, limited support for ongoing implementation and adoption of improved practices. SO WHAT?: Poor nutrition and growth in children in remote Aboriginal and Torres Strait Islander communities indicates the need for the ongoing commitment to and investment in nutrition and physical activity across a range of community settings. To achieve success, this requires a dedicated preventative health workforce supporting evidence-informed, coordinated programs driven by community priorities and developed via community development approaches.

Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community-led supportive environment approach.

OBJECTIVE: To create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. METHODS: This paper applied qualitative and quantitative methods to evaluate a co-designed multi-strategy health promotion initiative, implemented over 12 months from 2017 to 2018. Outcome measures included changes in community readiness, awareness of the social marketing campaign and changes in drink availability. Changes in store drink sales were measured in one community and compared to sales in a control store. RESULTS: Community readiness to address sugary drink consumption increased in two of the three communities. Awareness of social marketing campaign messaging was high (56-94%). Availability of drinking water increased in all communities. Water sales as a proportion of total drink volume sales increased by 3.1% (p<0.001) while sugary drink volume sales decreased by 3.4% (p<0.001). CONCLUSIONS: A multi-component strategy with strong engagement from local government, community leaders and the wider community was associated with positive changes in community readiness, drink availability and sales. Implications for public health: Partnering with community leaders in the co-design of strategies to create environments that support healthy drink consumption can stimulate local action and may positively affect drink consumption.