Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, 90095, United States.
Colorado School of Public Health, Aurora, CO, 80524, United States.
Matern Child Health J. 2022 Aug;26(Suppl 1):216-228. doi: 10.1007/s10995-022-03435-0. Epub 2022 May 21.
Childhood obesity disproportionately affects low-income women, children, racial/ethnic minorities, and rural populations. To effectively promote sustainable change, healthy eating and active living initiatives should apply individual plus policy, systems, and environmental (I + PSE) approaches.
Four public health maternal and child nutrition teams selected through an application process participated in 12 months of technical assistance (TA) to develop action plans incorporating I + PSE in nutrition programming. TA included: (1) online modules; (2) community of practice (CoP) meetings; and (3) individual coaching sessions. Teams completed midpoint and endpoint surveys to assess TA knowledge and process outcomes. Semi-structured, in-depth interviews conducted post TA were transcribed and content analysis used to characterize themes and sub-themes.
Facilitators to implementing I + PSE approaches included TA delivery through online modules, participation in the CoP, and individual coaching to address barriers to implementation and leadership support. Barriers were time and funding limitations, working in isolation, and lack of infrastructure and self-efficacy. Co-learning helped TA teams overcome stagnancy and promote development of creative solutions. Teams recognized relationship-building as integral to systems development.
Lessons learned occurred across three main areas: relationships, capacity-building, and barriers encountered. Relationship formation takes time and is often not recognized as an asset impacting public health programing. Relationship direction - upstream, downstream, and lateral - affects ability to build organizational and systems capacity. While this study includes a small number of public health nutrition teams, this practice-based research highlights the value of I + PSE TA to tackle complex problems, with reciprocal, multisectoral support to enhance public health nutrition program impact.
儿童肥胖症不成比例地影响低收入妇女、儿童、少数族裔和农村人口。为了有效促进可持续变革，健康饮食和积极生活倡议应采用个人加政策、系统和环境（I+PSE）方法。
通过申请程序选择了四个公共卫生母婴营养团队，参加了为期 12 个月的技术援助（TA），制定了行动计划，将 I+PSE 纳入营养计划。TA 包括：（1）在线模块；（2）实践社区（CoP）会议；（3）个人辅导课程。团队完成了中点和终点调查，以评估 TA 的知识和过程结果。在 TA 之后进行的半结构式深入访谈被转录，并使用内容分析来描述主题和子主题。
实施 I+PSE 方法的促进因素包括通过在线模块提供 TA、参与 CoP 以及针对实施障碍和领导力支持进行的个人辅导。障碍包括时间和资金限制、孤立工作以及缺乏基础设施和自我效能。共同学习有助于 TA 团队克服停滞不前的局面，并促进创造性解决方案的发展。团队认识到关系建设是系统发展的重要组成部分。
在三个主要领域都吸取了经验教训：关系、能力建设和遇到的障碍。关系的建立需要时间，而且往往不被视为影响公共卫生项目的资产。关系的方向——上游、下游和横向——影响组织和系统能力的建设能力。虽然这项研究包括少数公共卫生营养团队，但这种基于实践的研究强调了 I+PSE TA 解决复杂问题的价值，需要相互的、多部门的支持，以增强公共卫生营养项目的影响力。
