Influencing changes in dietary behaviors and physical activity in - PowerPoint PPT Presentation

Influencing changes in dietary behaviors and physical activity in developing countries: What do we know that works? Brian Oldenburg Melbourne School of Population & Global Health The University of Melbourne AUSTRALIA

Evidence gaps? 1. What do we know that we know? 2. What do we know that we don’t know? 3. What don’t we know at all?

Evidence gaps – Nutrition and physical activity & sedentariness 1. What do we know, we know? THE KNOWN KNOWNS? 2. What do we know, we don’t know? THE KNOWN UNKNOWNS? 2. What don’t we know at all? THE UNKNOWN UNKNOWNS?

Global translation and exchange

Individual & environment Individual Healthy eating Healthy activity Healthy weight Environment

Changing policy and the environment… Individual Healthy eating Healthy activity Healthy weight Policy & Environmental change

Our generic socio-ecological model for behavior change at an individual & population level e.g. diabetes Identify existing lifestyle behaviours link with diabetes Identify personal risk and need for resources and change Learn from lapses social support (Re-)Assess Identify “willingness” situation Identify links btw for specific behaviour and behavioural changes positive outcomes Individual Get positive embedded in feedback to Follow-up family, peer and Set goals encourage and group, maintenance increase neighborhood, Formulate willingness motivation community into SMART goals Review goal progress Link with personal and Plan family goals Establish collective Plan for action with linkages to commitment for community & family resources action + feedback and support: Where, when, how, from peers etc with whom? 10/12/2015

1. The Known Knowns?

What is the available evidence? 1. Review of Best Practice in Interventions to Promote Physical Activity in Developing Countries 14 – Systematic synthesis of peer reviewed literature – Consultation process with key stakeholders 2. Cochrane review on health promotion interventions effective in reducing cardiovascular diseases 15 3. Policy review on diet and PA 16 4. Review on school based interventions effective in reducing childhood obesity in LMICs 17 5. Recent advances in behavioral interventions in India: Diet 18 , Physical activity 19 , targeting high risk individuals for DM 20

1. Best practice physical activity interventions in developing countries Conduct local physical activity programs and initiatives; Raise awareness of the importance and benefits of physical activity among the Build capacity among population, individuals implementing Physical local physical activity activity programs through training interventions of potential program implemented coordinators Educate the whole currently in population and/or LMICs 14 specific population groups Recognition/awards to individuals who live a healthy lifestyle, engage in regular physical activity, Create supportive environments and encourage others to do that facilitate participation in so physical activity

Best practice physical activity interventions in developing countries Type of program Countries Nature of interventions • Singapore 1,2 , China-Hong Kong National program Creating a supportive SAR 3 , Malaysia 4 , Philippines 5 , environment • Marshall islands, Fiji, Thailand 6 , Raising awareness • South Africa, Slovenia 12 , Mass media Campaigns • Poland 13 , Pakistan 7,8 Network of sports and health workers • Community wide screenings Mass media based health education campaigns based on the principles of social • marketing • Workplace-based Health India Behavioral modification Education Intervention in ten strategies • locations information dissemination Community based programs Islamic Republic of Iran 9 Mass media, special events and targeting few areas exercise regulations

Best practice physical activity interventions in developing countries (cont’d) Type of program Countries Nature of interventions • Columbia 10,11 Conducted in the capital city of Creating a supportive Bogotá, with a population of 7 environment • million inhabitants in 20 localities Raising awareness • Mass media Campaigns • Community based interventions Brazil Community-wide in Sao Paulo intervention Permanent actions by local organizations for promoting the physical activity message in the community, Supportive actions by other institutions, mega events like Agita Galera

Best practice physical activity interventions in developing countries (cont’d) • Interventions were implemented as part of a national action plan or strategy, such as for NCD prevention and control, health promotion, or physical activity promotion (Fiji, Mauritius, Pakistan, Samoa, South Africa, Thailand, Tonga) • Few countries had set specific committees on physical activity promotion within a leading governmental agency.

2. Key findings from Cochrane review on health promotion inventions for CVD in LMIC 15 • Evidence base in LMICs is sparse • 13 trials that recruited 7310 participants • Two trials on healthy participants , 11 among those with cardiovascular risk, hypertension and T2DM • Turkey-3, China-1,Mexico-1,China & Nigeria-1, one each from Brazil, India, Pakistan, Romania and Jordan • Interventions limited to dietary advice and advice on physical activity • Duration: 6 to 13 months (mean follow up-13.3 months)

Key findings from Cochrane review (cont’d) • Evidence for effects on cardiovascular disease events was scarce. • Multiple risk factors interventions may lower – systolic blood pressure – diastolic blood pressure – body mass index and – waist circumference. • No difference for eating more fruit and vegetables, rates of smoking cessation, fasting blood sugar, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and total cholesterol. • Compromised quality of trials, hence results have to be read with caution.

3. Policy response to NCD’s in LMIC’s 16 • Information on the availability of policies for 83% (116/140) countries of the 140 LMICs found in the six WHO regions • Inadequate since endorsement of the Global Strategy on Diet, Physical Activity and Health

Modify fat intake* Limit salt intake*  Use of dietary guidelines and food labeling  Raising awareness  Collaboration with the food industry  Food labeling  for product reformulation,  Promotion of foods, snacks,  Establishment and enforcement and packaged seasonings  of food standards with reduced salt content  Product reformulation in *13/116 countries private sector *20% (23/116 countries ) Increase physical Increase fruit and Policy actions activity* vegetable intake* taken in LMICs  Public education and sensitization  Promotion of school gardening,  Targeting educational home gardening, institutions and workplace  Urban agriculture  Develop sports  Catering services in infrastructure and urban educational and government planning institutions to ensure strict  Explicit actions to involve inclusion of fruits and the private sector vegetables in the meals. *10/116 countries  Special recipe books *36/116 countries

Atlas of availability of national actions to limit salt or fat intake or increase fruit and vegetable intake or physical activity.

4. Evidence and gaps on school based interventions in LMICs 17 • Multicomponent interventions were more effective – education-based interventions delivered by teachers, providing additional PA sessions or integrated classes about healthy foods- nutrition, or PA to encourage children to adopt a healthy lifestyle • Role of family was crucial • Very few of them had used a theoretical framework for the intervention design which is very crucial to tailor the relevant proximal and distal outcomes to the participants’ context • Lack of information on process evaluation and the cost effectiveness of the interventions

5. Recent advances in PA and diet interventions in India • Importance of a theoretical framework of behavioral change that is context specific, culturally tailored 18,19,20 • Lifestyle change strategies involve reciprocal support with family 18,19,20 , peer 19,20 and community 18,18,20 • Family and community-based vs individualistic approach

2. The Known Unknowns?

We need to apply what we know and transfer what we know between cultures, settings and populations recognizing that “one size/approach does not fit all” IMPLEMENTATION SCIENCE

The Innovation Funding Setting • Development • Health care or other system • Implementation • Evaluation Target population • Demographic variables Development <-> Implementation <-> Evaluation • At risk Cultural Translation Program elements Organisations • Theoretical basis • Leaders • Key components • Strategic local partners • Materials • Strategic national partners • Delivery • Operational partners • Training • Research partners Ref: Oldenburg B et al. The Program transfer, adoption & uptake into spread of diabetes prevention programs around the world. policy and practice TBM, 2011, 1: 270-282

How do different populations understand prevention? 12.10.2015 Pilvikki Absetz 2013 28