Introduction and rationale for selecting the topic and the target group
A study in 2000 suggested that British teenagers were doing far less exercise than their peers in early 90’s (British Heart Foundation Report- Couch Kids: The Growing Epidemic). The report by the British Heart Foundation warned that the rise in obesity in teenagers is worrying as the onset of obesity in teens could transform into obesity in adulthood also. Child obesity is also prevalent, but what is worrying about the obesity in teens is that there is little time to change things before adult habits set in and a lot that could go wrong in the near future for this target age group.
Teenagers face a lot of transitions including physiological and psychological transition in their teen years. This period in life is often related to the onset of changes in family structures and relationships, social behaviour and interaction, education and professional goals. Obesity and problems related to it at this critical juncture can overshadow all these events in the life of teens. Various studies,( including Sobal J, Stunkard A,1989) indicate that obesity is negatively correlated to adverse social and economic state. Such studies also say obesity can be an antecedent to adverse social behaviour. As reported by BHFNC, obesity is known to cause cardiovascular disease, type 2 diabetes, some cancers, musculoskeletal disorders, gallbladder disease and adverse psychological behaviour. Hence it is important that tackling obesity in this target group should be a priority.
There is recent statistical evidence that builds on to the earlier discussed British Heart Foundation report. Statistics from hearstarts.org (2008) suggest that between 1994 and 2006 the percentage of obese men has risen from 14% to 25% and the figure for women in the same period has seen a rise from 19% to 29%. It also mentions that between 1995 and 2006 obesity in boys increased from 11% to 17% and from 12% to 15% in girls. Reports from diverse studies highlight the problem having grown to alarming proportion. Much worse has been predicted by a 2008 Foresight report putting the potential 60% of the UK adult population to be obese by 2050.
Child obesity is a problem and tackling obesity at the earliest possible instance is the best means of reducing its level. But since the problem has reached alarming proportion, quick preventive measures are needed to ensure that teens at high risk are prevented from being obese.
Specific aims and objectives of the initiative
Various definitions for obesity exist. However, obesity can be generally defined as a body state where excess fat has accumulated leading to a potential adverse health risk. It is a state where the body mass index has increased beyond desirable levels. The condition of obesity is linked to the age, height and weight of the individual.
The target group has been decided as the high risk teen population as it might be a last chance to arrest the spread of obesity amongst this target group. The approach of the initiative is to have a set of objectives that will serve as short term measures and long term aim to successfully measure the results of the initiative. The short term measures will also serve as milestones to enable the tracking of the initiatives progress.
This initiative is designed on the principles of AIDA (attention, interest, desire and action). Grabbing attention, generating interest and creating desire are the objectives. The aim of this initiative is to generate action and then measure the action to study the effectiveness of the initiative. The AIDA mode will be used in conjunction with the theories of health promotion. Grabbing attention is the foremost challenge as the target audience is used to having an independent mind set, being involved in various activities and at times giving less importance to their own well being and having short term targets for themselves rather than looking at their long term well being. After grabbing attention it is important to hold their attention which is possible by creating interest in dealing with obesity. The target audience will be able to deal with obesity effectively only when they have the desire to do so. Finally, this has to be followed up with action on the part of the target audience to tackle obesity. Even the NHS strongly advocated that drastic measures like surgery could be helpful in the short term but it is the motivation and actions of the obese person that are the final determinants in successfully tackling obesity. The health promotion theories will help guide the implementation of the initiative whereas the AIDA model will be used to track the cognitive and behavioural changes in individuals.
Review of relevant literature
The literature reviewed showcases different causes of obesity in developed versus the underdeveloped or developing countries. The prevalence of obesity in terms of its extent and reasons for increase were very different in the developed and developing world till a decade ago. In the current scenario it seems that the difference is getting blurred and the developing nations too are grappling with similar problems. Most of the literature reviewed of the developing countries seems to be focused on the lack of outdoor activities that the children are involved in, the amount of time that teens are spending in front of the television or playing computer games, alcoholism and drug abuse, not realising where to draw line in stopping to eat, the breakdown of the social structure and lack of proper counselling. Some of the literature reviewed studies the influence of education levels and economic development on obesity. In 1989, Sobal and Stunkard studied the relation between socioeconomic status and obesity in developing countries. Subsequent studies like Socioeconomic Status and Obesity (Sobal J, Stunkard A.J, updated by Lindsay McLaren) have also focused on the same subject but like other studies it talks about the blurring of the causes of obesity between developed and developing countries. One thing that is common across the literature reviewed is that obesity is a increasing across all age groups and it is spreading from the well-off socioeconomic segments in developing countries to the general population.
Theories of health promotion
An Ecological Perspective on Health Promotion Programs
McLeroy, Kenneth R (Health Education Quarterly, v15 n4 p351-77 Win 1988) explains the change in social environment that will help bring about change in individuals. It emphasises the need for interventions to change interpersonal, organisational, community and public policy factors. The central aim of the theory is that as environmental changes will influence individual, the individual also has a central role in changing the environment.
The Health Promotion Agency (www.healthpromotionagency.ork.uk) segregates the health promotion theories into:
- Theories that explain health behaviour change by focusing on the individual.
- Theories focusing on change in communities and community action
- Models focusing on changes in organisations and health supportive organisations
Contents of the talk, display, leaflets or other resources
The talk will be tied together using the earlier discussed AIDA framework. The talk will be focused on educating the target audience, developing their understand of the problem they face, the consequences of not dealing with the problem, understanding the reasons of their inertia in dealing with the problem, counselling and suggesting methods to deal with the problem and developing a road map that can see them through.
Many overweight teens do not seem to know the difference between being overweight and obese. The talk will explain the difference and try to highlight the fine line that distinguishes the both, as well as explaining the immediate problems that obesity can bring to the target audience. The immediate problems could be social problems dealing with rejection by the peer group, economic problem of being unable to work effectively in a demanding office environment or personal problems dealing with feelings of low self worth and self-esteem.
There is bound to be inertia in dealing with the problem. The consequences of not dealing with the problem need to be communicated. The reasons for inertia need to understand and this would be made possible either through one to one conversations or by conducting focus groups that are representative of the target audience. The focus groups can be conducted on a sample of the population but with the right methods of sampling the focus group takeaways can be extrapolated to the target audience.
The talk will draw from the insights of the one to one conversations or/and the focus groups to draw up common strategies to deal with inertia and the major problems that the target audience faces due to obesity. The talk will be used as a quick counselling session that will deal with the top issues. It will incorporate the issues that are based on the Pareto principle. The Pareto principle will be used to deal with the top 20 percent issues that relate to 80 percent of the target audience. This will help devise a communication plan that is inclusive, concise and has the potential to be tailor made to the individual needs. But since it aims to encompass 80 percent of the issue faced by the individual the customisation needed to deal with specific individuals will be limited and hence it would take less time to address the issues faced by the overall population.
The road map will be a mixture of medical hard facts, individual problem resolution and community support that can be sought. Medical hard facts will be used to drill down the facts that maybe the individual is ignoring by putting off plans to curb obesity or in some cases where the individual is not recognising the fact that he is obese. These hard facts will also be used to understand the current medical risks that the individual might face. The reasons for obesity could be related to lifestyle and eating habits, hormonal changes or related to other biological problems. These problems would be individual assessed to draw a road map. Target audience with these problems can be classified into broad segments based on these problems and hence the road map can offer segment specific problem resolution that could in turn be applied at individual level.
The displays used in the communication would try and encompass the personas of various segments of individuals. The target audience can be further divided into segments based on probable variables like ethnicity, socioeconomic background, education and symptoms of obesity. The displays will help the target audience connect with them as it would be a reflection of their personas. The displays will carry a description of their persona, what their daily life routine is, the risk of obesity, short and long term problems associated and steps to curb obesity. The displays will be meant to generate interest and desire and guide them to health professionals or counselling where they can get professional help. The leaflets will detail out the follow up action items as they will serve as take outs which the target audience can retain.
The initiative is designed to create a paradigm shift and help the target audience to realise the enormity of the problem phased, its repercussions and where they can get professional help. It is merely meant to augment the existing medical and counselling care that can be made available to the target audience. The research shows that obesity is not merely a biological problem. The understanding of the problem, the willingness to curb obesity and the willpower to go and meet weight reduction is a challenge. This initiative is designed to take care of these issues in reducing obesity.
A health belief model will be leveraged for the initiative. The health belief states that a person would be encouraged to take positive action if he feels threatened by the current health state or feels that something positive can be done and has the belief that he can follow the advice and improve his health state. This is an important element of the initiative to work with teens. Teens can be indifferent, careless, unaware or confused about their health condition. It is imperative that they are made to realise the problems they potentially face. After the realisation sinks in it is important that health belief model approach is employed to ensure that the target audience believes that change of current health status is possible.
Another model that will be leverage is the social learning model. Teens are susceptible to peer pressure and have role models that might not be the right role models to have. Social learning theory states that a person’s behaviour might be influenced by his environment. Learning might take place without any apparent change in behaviour. In the case of teens, the social environment reinforces a lot of their behaviour. An obese teen’s negative feeling about him or herself may be reinforced by discrimination by his social network. To tackle obesity it is necessary that the social environment of teens is better understood and interventions made where necessary.
Evaluation of the initiative
As stated earlier the aim of the initiative is to generate action. The target audience would benefit immensely when obesity is successfully curbed. The initiative will endeavour to put the target audience on the path to curbing obesity. However, the success of the initiative cannot be solely judged on the fact whether the obesity has been curbed. There are two reasons behind this. The first reason being that the objectives of the initiative relate to grabbing attention, creating interest that leads to desire amongst the target audience to do something positive about the issue. These objectives if successful do not guarantee a remedy to the problem. The second reason is that the objectives, when successful, have to be supported by the medical and social systems that have been put in place by the government and various organisations.
Hence, the evaluation of the initiative will be based on the population of the target audience and the percentage of the audience who have reacted positively to each of the three objectives. Greater weight age will also be given to the percentage of teens that have taken some action to reduce obesity. The number of teens reducing obesity and the degree of reduction will also be given weight age at par with the three objectives. A qualitative survey will also be undertaken to judge the quality of counselling provided to the teens.
Recommendations for future health promotion initiatives
Initiatives for teens should reflect upon the role that their parents have played. Even though commercial advertising, school and college eating options and eating out options are becoming healthier, the important role of the parents has not diminished. If the parents and the immediate family can provide psychological and moral support to the teens then it can be a big boost for them in their fight against obesity. Approaches to increase involvement of parents in teen obesity reduction initiatives should be evaluated.
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