Gemeinschaftsmedizin und Gesundheitserziehung

Abstrakt

The Health Equilibrium Initiative-Is it Possible to Prevent Intervention- Generated Inequality?

Magnusson M, Pickering C and Lissner L

Introduction: Obesity is unequally distributed between socio-economic Groups. Public health interventions may, unintentionally, contribute to widen health gaps. The approach Community based participatory research (CBPR) offers potential to narrow such gaps. CBPR needs to be adapted to the Nordic context and thus tested in appropriate settings. The aim was to examine the potential for a CBPR intervention to decrease childhood obesity in an underserved community in a major Swedish city. Methods: Activities were planned together with target groups, using Social Cognitive Theory. Activities were documented by structured reports aiming at developing knowledge and minimizing risk of harm. From determinants for healthy behavior (reciprocal determination, self-efficacy, learning by observation, facilitation and expectations of outcome) strategies for health promotion were formed. Viewpoints from collaborators were collected. Families in schools in areas where many had low education, low income and where many were recent immigrants, were invited to examinations that were discussed in the context of the participatory intervention. Examinations included anthropometric measurements, interviews on life style habits and neuropsychological assessments. Data were analyzed by independent sample t-test, Chi-square tests, one way Anova, content analysis and the CANTAB protocols, respectively. Results: Changes on structural levels were initiated during the intervention. Guidelines to remove sweets from schools were difficult to implement. 35% (n=119) of the initially invited sample participated at follow-up. At follow-up there was no difference between children in control and intervention schools. There was no evidence for links between weight and cognitive development in children. Conclusion: For participatory public health interventions time must be allocated to develop them in concert with target groups. To justify efforts and costs all steps should be thoroughly documented, transparent and evaluated. Policies to minimize sweets in schools need increased support from management levels. Participatory interventions can provide insights that cannot be obtained by traditional methods.