Improving low fruit and vegetable intake in children: Findings from a system dynamics, community group model building study

Abstract

Many children globally do not meet government guidelines for daily fruit and vegetable intake, and in New Zealand, adherence to the vegetable intake recommendation is declining. This study aimed to identify systemic barriers to children meeting fruit and vegetable (FV) guidelines and generate sustainable actions within a local community to improve children’s FV intake. A qualitative system dynamics method of community group model building was used. The research team partnered with Healthy Families Waitākere, a Ministry of Health funded prevention initiative, to recruit 17 participants (including students, parents, teachers, community leaders, local retailers and health promoters) from a low-income, ethnically-diverse community in West Auckland, New Zealand. Three group model building workshops were held during which a systems map was created and used to identify actions by considering causal pathways and reinforcing loops in the system. Barriers to children’s FV intake identified by participants were the saturation of fast-food outlets in the community and ubiquitous marketing of these products, the high cost of fresh produce compared to fast food, and parents having little time for food preparation plus declining cooking skills and knowledge. Several actions to improve children’s FV intake by improving the local food environment were identified, which will be co-designed further and tested by a collaborative group involving community leaders. This project highlights the effectiveness of group model building for engaging a local community in systems change to improve child nutrition, and supplies a blueprint for future qualitative system dynamics research.

Early Childhood Junk Food Consumption, Severe Dental Caries, and Undernutrition: A Mixed-Methods Study from Mumbai, India

“…Early and frequent exposure to sweets can develop taste preferences, addiction to sugar, and lifelong habits contributing to poor oral health and nutrition and other NCDs [ 29 ]. These findings support other studies on accessibility and consumption of junk food by very young children, and junk food marketing to attract school-aged children to purchase snacks afterschool [ 8 , 30 , 31 , 32 ]. These food-environment challenges highlight the need for policy initiatives such as prohibiting marketing of junk food to children, adding warning labels on unhealthy products, and taxing sugary drinks and snacks [ 33 , 34 , 35 ].…”

A systems map of the determinants of child health inequalities in England at the local level

“…Systems approaches have been frequently applied to complex public health problems, and in child health the focus has most often been on single outcomes, in particular healthy eating [27] and obesity [50]. We believe the approach described in this paper is novel in scope, by asking participants to consider inequalities across all health outcomes, and for all populations of children and young people aged 0-25 years.…”

“…The majority of published studies using system approaches to address child health have focused on healthy eating and obesity, with a paucity of studies using systems approaches to other child health outcomes [19,21,[26][27][28][29]. The current study seeks to extend the scope of a systems mapping approach beyond single child health outcomes to address inequalities in child health more broadly.…”

Building a Prevention System: Infrastructure to Strengthen Health Promotion Outcomes

“…Systems thinking is drawn from the overlapping sciences of systems theory and complexity theory [ 19 ], where system dynamics and soft systems methodology are considered to be the relevant approaches to health promotion [ 5 , 20 , 21 ] that are currently being used in community-based prevention [ 22 , 23 , 24 , 25 , 26 ]. These methods shift the focus of health promotion activities away from a reductionist perspective to a holistic one [ 27 ], recognising that the essence of structure is not the parts themselves, but the relationships between the parts, their causal connections [ 2 ].…”