Understanding System-Level Intervention Points to Support School Food and Nutrition Policy Implementation in Nova Scotia, Canada

McIsaac, Jessie‐Lee D.; Spencer, Rebecca; Stewart, Melissa; Penney, Tarra L.; Brushett, Sara; Kirk, Sara F. L.

doi:10.3390/ijerph16050712

Cited by 8 publications

(9 citation statements)

References 47 publications

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“…The ILF comprises (from highest to lowest impact): paradigm, goals, system structures, feedbacks and delays, and structural elements. Specific to school settings, McIssac [ 28 ] further summarised data aligned to the ILF into three themes of intervention points within the school food system (from highest to lowest impact): purpose and values, system regulation and interconnections, and actors and elements. The ILF has been used successfully utilised to code pre-conference reading, and high-level documents (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Given the work of Malhi [ 20 ], Johnston [ 18 ], McIssac [ 28 ] and Nobles [ 19 ] to operationalise M12 with the specified intent to improve usability for public health and policy practitioners with each iteration, why create something new? We argue that we have not created something new but translated the M12 into language useful for public health practice.…”

Section: Discussionmentioning

confidence: 99%

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The Public Health 12 framework: interpreting the ‘Meadows 12 places to act in a system’ for use in public health

et al. 2022

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Background Systems science approaches have demonstrated effectiveness in identifying underlying drivers of complex problems and facilitating the emergence of potential interventions that are locally tailored, feasible, sustainable and evidence informed. Despite the potential usefulness of system dynamics simulation modelling and other systems science modelling techniques in guiding implementation, time and cost constraints have limited its ability to provide strong guidance on how to implement complex interventions in communities. Guidance is required to ensure systems interventions lead to impactful systems solutions, implemented utilising strategies from the intersecting fields of systems science and implementation science. To provide cost-effective guidance on how and where to implement in systems, we offer a translation of the ‘Meadows 12 places to act in a system’ (Meadows 12) into language useful for public health. Methods This translation of Meadows 12 was informed by our experience in working with 31 communities across two complex large scale randomised control trials and one large whole of community case study. These research projects utilised systems science and implementation science to co-create childhood obesity prevention interventions. The team undertaking this translation comprised research academics, implementation specialists and practitioners, practice-based researchers and a systems dynamicist. Our translation of each of the Meadows 12 levels to act in the system maintains the fidelity and nuance of the 12 distinct levels. We provide examples of each level of the Public Health 12 framework (PH12) drawn from 31 communities. All research was conducted in Victoria, Australia between 2016 and 2020. Results PH12 provides a framework to guide both research and practice in real world contexts to implement targeted system level interventions. PH12 can be used with existing implementation science theory to identify relevant strategies for implementation of these interventions to impact the system at each of the leverage points. Conclusion To date little guidance for public health practitioners and researchers exists regarding how to implement systems change in community-led public health interventions. PH12 enables operationalisation Meadows 12 systems theory into public health interventions. PH12 can help research and practice determine where leverage can be applied in the system to optimise public health systems level interventions and identify gaps in existing efforts. Trial registration WHO STOPS: ANZCTR: 12616000980437. RESPOND: ANZCTR: 12618001986268p.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Public Health 12 framework: interpreting the ‘Meadows 12 places to act in a system’ for use in public health

et al. 2022

View full text Add to dashboard Cite

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“…Other practices, such as the use of foods and beverages for classroom celebrations and rewards, are also widespread, with the latter more common in secondary schools. Although this study was limited in its investigation, literature from North America illustrates that students consume mainly low-nutrient, energy-dense items during celebrations [ 51 ], that there is a lack of alternatives to using unhealthy food in fundraising, and that ‘special treats’ undermine the move towards healthier food environments in schools [ 52 ]. The variability in such practices between teachers and schools has resulted in scant research investigating its impact on health.…”

Section: Discussionmentioning

confidence: 99%

Culture of Healthy Eating and Food Environments, Policies, and Practices in Regional New Zealand Schools

Chote

McKelvie-Sebileau

Swinburn

et al. 2022

IJERPH

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The school food environment plays an important role in shaping students’ dietary choices, which often influence future dietary behaviours. We surveyed primary and secondary schools in Hawke’s Bay, New Zealand, to measure the comprehensiveness and strength of food policies, describe the culture of food provision, and identify barriers to improving school food environments. Fifty-one schools were included in the final analysis, with 58.8% having a food policy, most of which used a generic template. Schools with food policies and those participating in the free and healthy lunch programme were more likely to have a strong culture around healthy eating. Common barriers to healthy eating were food outlets near school and resistance from students. Secondary schools reported facing more barriers to implementing healthy eating cultures, were more likely to use food as classroom rewards and to sell food to students, most of which was unhealthy. Hawke’s Bay schools participating in food provision programmes are successfully improving their food environments through improved culture and delivery of healthy food; however, more action is needed to strengthen the wording and guidance in food policies and reduce the provision of unhealthy food in schools before effective change can be achieved.

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“…For example, the Iceberg Model 15 is used predominantly within the private sector to facilitate change management efforts, and the ILF 16 has been adopted by researchers in the public health field to evaluate interventions, policies and systems change. 2,10,29,31 We hope that the ASM can be used for several purposes: to understand why the system works as it does, to identify and subsequently appraise actions and finally, to guide elements of an evaluation. Thus, the purpose and use of the ASM differs from previous models in that its application is broader, but due to the simplicity of the model and the ease of understanding, it can be applied without the expertise of a third party.…”

Section: Strengths and Limitations Of The Asmmentioning

confidence: 99%

The Action Scales Model: A conceptual tool to identify key points for action within complex adaptive systems

Nobles¹,

Radley

Mytton

2021

Perspect Public Health

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Background: Systems thinking is integral to working effectively within complex systems, such as those which drive the current population levels of overweight and obesity. It is increasingly recognised that a systems approach – which corrals public, private, voluntary and community sector organisations to make their actions and efforts coherent – is necessary to address the complex drivers of obesity. Identifying, implementing and evaluating actions within complex adaptive systems is challenging, and may differ from previous approaches used in public health. Methods: Within this conceptual article, we present the Action Scales Model (ASM). The ASM is a simple tool to help policymakers, practitioners and evaluators to conceptualise, identify and appraise actions within complex adaptive systems. We developed this model using our collective expertise and experience in working with local government authority stakeholders on the Public Health England Whole Systems Obesity programme. It aligns with, and expands upon, previous models such as the Intervention Level Framework, the Iceberg Model and Donella Meadows’ 12 places to intervene within a system. Results: The ASM describes four levels (synonymous with leverage points) to intervene within a system, with deeper levels providing greater potential for changing how the system functions. Levels include events, structures, goals and beliefs. We also present how the ASM can be used to support practice and policy, and finish by highlighting its utility as an evaluative aid. Discussion: This practical tool was designed to support those working at the front line of systems change efforts, and while we use the population prevalence of obesity as an outcome of a complex adaptive system, the ASM and the associated principles can be applied to other issues. We hope that the ASM encourages people to think differently about the systems that they work within and to identify new and potentially more impactful opportunities to leverage change.

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Understanding System-Level Intervention Points to Support School Food and Nutrition Policy Implementation in Nova Scotia, Canada

Cited by 8 publications

References 47 publications

The Public Health 12 framework: interpreting the ‘Meadows 12 places to act in a system’ for use in public health

The Public Health 12 framework: interpreting the ‘Meadows 12 places to act in a system’ for use in public health

Culture of Healthy Eating and Food Environments, Policies, and Practices in Regional New Zealand Schools

The Action Scales Model: A conceptual tool to identify key points for action within complex adaptive systems

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