EEN Key activities, September 2010
Research in progress from the Free University of Amsterdam, on the Scientific Evaluation and Dissemaination of EPODE, for the EPODE European Network - Dr Marje van KOPEREN
Within the EEN-project, the Faculty of Earth and Life sciences, Prevention and Public Health section of the Free University of Amsterdam, is collaborating to study the scientific framework for evaluation and dissemination of Community Based Interventions like EPODE. Led by Prof. Jaap Seidell and Prof. Tommy Visscher, Dr Marije van Koperen presents the first reflections on this central topic.
Outline and Objectives
EPODE has been proven effective on the prevention of obesity and overweight in children (Romon, 2008). To gain better insight in the process leading to these effects, guide current evaluation and support European implementation, the EEN has requested the Vrije University of Amsterdam to conduct a research on the evaluation methods of the EPODE program. The objective of this research is to create an evaluation framework and guidelines for the monitoring and evaluation of the EPODE methodology and similar community based health promotion programs. The research addresses issues of evaluation design, key-variables to measure, evaluation methods, overweight measurements in children and dissemination of results. The research methodology is visualized in figure A.
Figure A: visualization of the EEN Scientific evaluation and dissemination research
Main findings from literature research and interviews with EPODE professionals
EPODE is a community based health promotion program with the intention to decrease or stabilize the prevalence of overweight and obesity in children within that community. The rationale for a community based health promotion program is the notion that individuals cannot be considered separately from their social environment and context. Therefore community based health promotion programs, such as EPODE, incorporate multiple interventions extending beyond the individual level; in doing so they seem to have more success in changing behaviors than those who do not. Other important elements of community based health promotion programs such as EPODE are empowerment, social network approach, capacity building, multi-sectoral collaboration and the use of an intervention mix.
In order to compare communities in their efforts to prevent overweight and obesity it is important that evaluations are consistent. Since the communities that use the EPODE methodology differ in population and geographic size, economic status, culture (social and political) and environment the evaluation needs and resources to perform an evaluation differ as well. Therefore the creation of a generic evaluation framework is challenging.
By nature of community based health promotion programs, a classic evaluation design as a randomized controlled trial is not advised; many inhibiting and promoting factors and actors play a role and causal relations are hard to determine. It is therefore suggested to use a pre-test-post-test design to measure change in the behavior of the individual and the community. The use of a control town (not necessarily randomized) is advised when allowed by time and resources. Important in the monitoring and evaluation of EPODE and the alike is the use of a mixed method approach in data collection (both qualitative and quantitative), to make use of trained people to collect data, to stimulate stakeholders to participate in evaluation set-up and data-collection, to focus not only on outcome but also on impact and process evaluation and to disseminate intermediate successes, not only the final outcome. And last but not least: to dedicate 10-15% of program budget to program evaluation.
Leading in the construction of an evaluation framework are the program goal(s), program objectives, resources, implementation strategy and stakeholders. The EPODE program theory (fig. B) was based on these program constructs and followed the logic model approach on four levels: national organization, local organization, community and child level. The so determined key-elements of the program need to be part of the evaluation.
Fig B: EPODE program theory
Measurement of Obesity in Children
For outcome measurement BMI, adjusted for age and gender (IOTF cut-off values), is internationally recommended as a practical estimate of overweight in children. It is easy to obtain, it has a strong correlation with body fat percentage, a weak association with height, and the ability to identify individuals with acceptable accuracy. However the BMI should be interpreted with caution since it is not a direct measure of body fat therefore it is recommended for studies to use validated methods for the estimation of body fat and they should also assess the benefits of additional measures such as waist circumference and skinfold thickness. Since the accuracy of the anthropometric measurements depends strongly on the skills of the measurer and the precision of the measuring equipment the use of (inter) national guidelines/protocols and trained personnel are recommended.
EEN Newsletter N°5 – September 2010