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Waqa G.,Fiji National University | Mavoa H.,Deakin University | Snowdon W.,Fiji National University | Snowdon W.,Deakin University | And 6 more authors.
Implementation Science | Year: 2013

Background: The importance of using research evidence in decisionmaking at the policy level has been increasingly recognized. However, knowledge brokering to engage researchers and policymakers in government and non-government organizations is challenging. This paper describes and evaluates the knowledge exchange processes employed by the Translational Research on Obesity Prevention in Communities (TROPIC) project that was conducted from July 2009 to April 2012 in Fiji. TROPIC aimed to enhance: the evidence-informed decisionmaking skills of policy developers; and awareness and utilization of local and other obesity-related evidence to develop policies that could potentially improve the nation's food and physical activity environments. The specific research question was: Can a knowledge brokering approach advance evidence-informed policy development to improve eating and physical activity environments in Fiji.Methods: The intervention comprised: recruiting organizations and individuals; mapping policy environments; analyzing organizational capacity and support for evidence-informed policymaking (EIPM); developing EIPM skills; and facilitating development of evidence-informed policy briefs. Flexible timetabling of activities was essential to accommodate multiple competing priorities at both individual and organizational levels. Process diaries captured the duration, frequency and type of each interaction and/or activity between the knowledge brokering team and participants or their organizations.Results: Partnerships were formalized with high-level officers in each of the six participating organization. Participants (n = 49) developed EIPM skills (acquire, assess, adapt and apply evidence) through a series of four workshops and applied this knowledge to formulate briefs with ongoing one-to-one support from TROPIC team members. A total of 55% of participants completed the 12 to18 month intervention, and 63% produced one or more briefs (total = 20) that were presented to higher-level officers within their organizations. The knowledge brokering team spent an average of 30 hours per participant during the entire TROPIC process.Conclusions: Active engagement of participating organizations from the outset resulted in strong individual and organizational commitment to the project. The TROPIC initiative provided a win-win situation, with participants expanding skills in EIPM and policy development, organizations increasing EIPM capacity, and researchers providing data to inform policy. © 2013 Waqa et al.; licensee BioMed Central Ltd.


Snowdon W.,Deakin University | Lawrence M.,Deakin University | Schultz J.,National Food and Nutrition Center | Vivili P.,Ministry of Health | Swinburn B.,Deakin University
Public Health Nutrition | Year: 2010

Objective To implement a systematic evidence-informed process to enable Fiji and Tonga to identify the most feasible and targeted policy interventions which would have most impact on diet-related non-communicable diseases. Design A multisectoral stakeholder group of policy advisers was formed in each country. They used participatory approaches to identify the problem policies and gaps contributing to an unhealthy food environment. Potential solutions to these problems were then identified, and were assessed by them for feasibility, effectiveness, cost-effectiveness and side-effects. Data were gathered on the food and policy environment to support the assessments. A shortlist of preferred policy interventions for action was then developed.Results Sixty to eighty policy problems were identified in each country, affecting areas such as trade, agriculture, fisheries and pricing. Up to 100 specific potential policy solutions were then developed in each country. Assessment of the policies highlighted relevant problem areas including poor feasibility, limited effectiveness or cost-effectiveness and serious side-effects. A shortlist of twenty to twenty-three preferred new policy options for action in each country was identified. Conclusions Policy environments in these two countries were not conducive to supporting healthy eating. Substantial areas of potential action are possible, but some represent better choices. It is important for countries to consider the impact of non-health policies on diets. © 2010 The Authors.


Fotu K.F.,Ministry of Health | Millar L.,Deakin University | Mavoa H.,Deakin University | Kremer P.,Deakin University | And 9 more authors.
Obesity Reviews | Year: 2011

Tonga has a very high prevalence of obesity with steep increases during youth, making adolescence a critical time for obesity prevention. The Ma'alahi Youth Project, the Tongan arm of the Pacific Obesity Prevention in Communities project, was a 3-year, quasi-experimental study of community-based interventions among adolescents in three districts on Tonga's main island (Tongatapu) compared to the island of Vava'u. Interventions focused mainly on capacity building, social marketing, education and activities promoting physical activity and local fruit and vegetables. The evaluation used a longitudinal design (mean follow-up duration 2.4 years). Both intervention and comparison groups showed similar large increases in overweight and obesity prevalence (10.1% points, n=815; 12.6% points, n=897 respectively). Apart from a small relative decrease in percentage body fat in the intervention group (-1.5%, P<0.0001), there were no differences in outcomes for any anthropometric variables between groups and behavioural changes did not follow a clear positive pattern. In conclusion, the Ma'alahi Youth Project had no impact on the large increase in prevalence of overweight and obesity among Tongan adolescents. Community-based interventions in such populations with high obesity prevalence may require more intensive or longer interventions, as well as specific strategies targeting the substantial socio-cultural barriers to achieving a healthy weight. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.


Snowdon W.,Deakin University | Snowdon W.,Fiji National University | Moodie M.,Deakin University | Schultz J.,National Food and Nutrition Center | Swinburn B.,Deakin University
Food Policy | Year: 2011

Background: To compare the likely costs and benefits of a range of potential policy interventions in Fiji and Tonga targeted at diet-related noncommunicable diseases (NCDs), in order to support more evidence-based decision-making. Method: A relatively simple and quick macro-simulation methodology was developed. Logic models were developed by local stakeholders and used to identify costs and dietary impacts of policy changes. Costs were confined to government costs, and excluded cost offsets. The best available evidence was combined with local data to model impacts on deaths from noncommunicable diseases over the lifetime of the target population. Given that the modelling necessarily entailed assumptions to compensate for gaps in data and evidence, use was made of probabilistic uncertainty analysis. Results: Costs of implementing policy changes were generally low, with the exception of some requiring additional long-term staffing or construction activities. The most effective policy options in Fiji and Tonga targeted access to local produce and high-fat meats respectively, and were estimated to avert approximately 3% of diet-related NCD deaths in each population. Many policies had substantially lower benefits. Cost-effectiveness was higher for the low-cost policies. Similar policies produced markedly different results in the two countries. Conclusion: Despite the crudeness of the method, the consistent modelling approach used across all the options, allowed reasonable comparisons to be made between the potential policy costs and impacts. This type of modelling can be used to support more evidence-based and informed decision-making about policy interventions and facilitate greater use of policy to achieve a reduction in NCDs. © 2011 Elsevier Ltd.


Thow A.M.,University of Sydney | Snowdon W.,Fiji National University | Schultz J.T.,National Food and Nutrition Center | Leeder S.,University of Sydney | And 2 more authors.
Obesity Reviews | Year: 2011

There is global interest in using multisectoral policy approaches to improve diets, and reduce obesity and non-communicable disease. However, there has been ad hoc implementation, which in some sectors such as the economic sector has been very limited, because of the lack of quality evidence on potential costs and impacts, and the inherent challenges associated with cross-sectoral policy development and implementation. The Pacific Obesity Prevention in Communities food policy project aimed to inform relevant policy development and implementation in Pacific Island countries. The project developed an innovative participatory approach to identifying and assessing potential policy options in terms of their effectiveness and feasibility. It also used policy analysis methodology to assess three policy initiatives to reduce fatty meat availability and four soft drink taxes in the region, in order to identify strategies for supporting effective policy implementation. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.


Snowdon W.,Deakin University | Potter J.-L.,Deakin University | Swinburn B.,Deakin University | Schultz J.,National Food and Nutrition Center | Lawrence M.,Deakin University
Health Promotion International | Year: 2010

Policies from non-health sectors have considerable impacts on the food environment and in turn on population nutrition. Health impact assessment (HIA) methods have been developed to identify the potential health effects of non-health policies; however, they are underused both within and outside the health sector. HIA and other assessment methods and tools can be used more extensively in health promotion to assist with the identification of the best policy options to pursue to improve and protect health. A participatory process is presented in this paper which combines HIAs with feasibility and effectiveness assessments. The intention is to enable health promoters to more accurately identify which policy change options would be most likely to improve diets, considering both impact and likelihood of implementation. The process was successfully used in Fiji and Tonga and provided a more systematic way of understanding which policy interventions showed the most promise.


Schultz J.T.,National Food and Nutrition Center | Moodie M.,Deakin University | Mavoa H.,Deakin University | Utter J.,University of Auckland | And 5 more authors.
Obesity Reviews | Year: 2011

Policy makers throughout the world are struggling to find effective ways to prevent the rising trend of obesity globally, particularly among children. The Pacific Obesity Prevention in Communities project was the first large-scale, intervention research project conducted in the Pacific aiming to prevent obesity in adolescents. The project spanned four countries: Australia, New Zealand, Fiji and Tonga. This paper reports on the strengths and challenges experienced from this complex study implemented from 2004 to 2009 across eight cultural groups in different community settings. The key strengths of the project were its holistic collaborative approach, participatory processes and capacity building. The challenges inherent in such a large complex project were underestimated during the project's development. These related to the scale, complexity, duration, low research capacity in some sites and overall coordination across four different countries. Our experiences included the need for a longer lead-in time prior to intervention for training and up-skilling of staff in Fiji and Tonga, investment in overall coordination, data quality management across all sites and the need for realistic capacity building requirements for research staff. The enhanced research capacity and skills across all sites include the development and strengthening of research centres, knowledge translation and new obesity prevention projects. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.


Kremer P.,Deakin University | Waqa G.,Fiji National University | Vanualailai N.,Fiji National University | Schultz J.T.,National Food and Nutrition Center | And 6 more authors.
Obesity Reviews | Year: 2011

Obesity is a significant problem among adolescents in Pacific populations. This paper reports on the outcomes of a 3-year obesity prevention study, Healthy Youth Healthy Communities, which was part of the Pacific Obesity Prevention in Communities project, undertaken with Fijian adolescents. The intervention was developed with schools and comprised social marketing, nutrition and physical activity initiatives and capacity building designed to reduce unhealthy weight, and the individual exposure period was just over 2-year duration. The evaluation incorporated a quasi-experimental, longitudinal design in seven intervention secondary schools near Suva (n=874) and a matched sample of 11 comparison secondary schools from western Viti Levu (n=2,062). There were significant differences between groups at baseline; the intervention group was shorter, weighed less, had a higher proportion of underweight and lower proportion of overweight, and better quality of life (Pediatric Quality of Life Inventory only). At follow-up, the intervention group had lower percentage body fat (-1.17) but also a lower increase in quality of life (Assessment of Quality of Life instrument: -0.02; Pediatric Quality of Life Inventory: -1.94) than the comparison group. There were no other differences in anthropometry, and behaviours' changes showed a mixed pattern. In conclusion, this school-based health promotion programme lowered percentage body fat but did not reduce unhealthy weight gain or influence most obesity-promoting behaviours among Fijian adolescents. Despite growing evidence supporting the efficacy of community-based approaches to reduce obesity among children of European descent, findings from this study failed to demonstrate the efficacy of a community capacity-building approach among an adolescent sample drawn from a different sociocultural, economic and geographical context. Additional 'top-down' or other innovative approaches may be needed to reduce adolescent obesity in the Pacific. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.


PubMed | University of New South Wales, Ministry of Health and Medical Services, National Food and Nutrition Center and Baker IDI Heart & Diabetes Institute
Type: Journal Article | Journal: Population health metrics | Year: 2016

Type 2 diabetes mellitus (T2DM) incidence is traditionally derived from cohort studies that are not always feasible, representative, or available. The present study estimates T2DM incidence in Fijian adults from T2DM prevalence estimates assembled from surveys of 25-64 year old adults conducted over 30years (n=14,288).T2DM prevalence by five-year age group from five population-based risk factor surveys conducted over 1980-2011 were variously adjusted for urban-rural residency, ethnicity, and sex to previous censuses (1976, 1986, 1996, 2009) to improve representativeness. Prevalence estimates were then used to calculate T2DM incidence based on birth cohorts from the age-period (Lexis) matrix following the Styblo technique, first used to estimate annual risk of tuberculosis infection (incidence) from sequential Mantoux population surveys. Poisson regression of year, age, sex, and ethnicity strata (n=160) was used to develop projections of T2DM prevalence and incidence to 2020 based on various scenarios of population weight measured by body mass index (BMI) change.T2DM prevalence and annual incidence increased in Fiji over 1980-2011. Prevalence was higher in Indians and men than i-Taukei and women. Incidence was higher in Indians and women. From regression analyses, absolute reductions of 2.6 to 5.1% in T2DM prevalence (13-26% lower), and 0.5-0.9 per 1000 person-years in incidence (8-14% lower), could be expected in 2020 in adults if mean population weight could be reduced by 1-4kg, compared to the current period trend in weight gain.This is the first application of the Styblo technique to calculate T2DM incidence from population-based prevalence surveys over time. Reductions in population BMI are predicted to reduce T2DM incidence and prevalence in Fiji among adults aged 25-64 years.


PubMed | Fiji National University, London School of Hygiene and Tropical Medicine, National Food and Nutrition Center and Deakin University
Type: | Journal: Appetite | Year: 2016

Low fruit and vegetable intake is an important risk factor for micronutrient deficiencies and non-communicable diseases, but many people worldwide, including most Fijians, eat less than the World Health Organization recommended amount. The present qualitative study explores factors that influence fruit and vegetable intake among 57 urban Fijians (50 women, 7 men) of indigenous Fijian (iTaukei) and South Asian (Indian) descent. Eight focus group discussions were held in and around Suva, Fijis capital and largest urban area, which explored motivation for eating fruit and vegetables, understandings of links to health and disease, availability and sources, determinants of product choice, and preferred ways of preparing and eating fruit and vegetables. Data were analysed using thematic content analysis. Regardless of ethnicity, participants indicated that they enjoyed and valued eating fruit and vegetables, were aware of the health benefits, and had confidence in their cooking skills. In both cultures, fruit and vegetables were essential components of traditional diets. However, increasing preferences for processed and imported foods, and inconsistent availability and affordability of high-quality, low-priced, fresh produce, were identified as important barriers. The findings indicate that efforts to improve fruit and vegetable intake in urban Fijians should target the stability of the domestic fruit and vegetable supply and access.

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