ORCID Profile
0000-0001-7266-5034
Current Organisations
Latrobe University
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Deakin University
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Publisher: Elsevier BV
Date: 10-2022
Abstract: To report the prevalence of healthy weight and related behaviours among Victorian Aboriginal and non-Aboriginal children and explore associations between these factors and health-related quality of life (HRQoL). Analysis of cross-sectional data from two cluster randomised controlled trials using logistic and linear mixed models. The s le included Aboriginal (n=303) and non-Aboriginal (n=3,026) children aged 8-13 years. More than two-thirds of Aboriginal children met guidelines for fruit (75.9%), sweetened drinks (66.7%), sleep (73.1%), screen time (67.7%) and objectively measured physical activity (83.6%) and 79.1% reported consuming take-away foods less than once per week. Aboriginal children were more likely to meet vegetable consumption guidelines (OR=1.42, 95%CI: 1.05, 1.93), but less likely to have a healthy weight (OR=0.66, 95%CI: 0.52, 0.85) than non-Aboriginal children. Mean HRQoL scores were significantly higher among non-Aboriginal children and both Aboriginal and non-Aboriginal children meeting health guidelines. Most Aboriginal children in this study met guidelines for fruit, physical activity, screen time and sleep, and those meeting these guidelines had significantly higher HRQoL. Promoting nutrition, physical activity and sleep is likely to benefit all children. Aboriginal community-controlled organisations can use these data to design culturally-specific programs that may improve disparities in healthy weight and HRQoL.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2021
DOI: 10.1186/S12966-021-01151-6
Abstract: Environments within schools including the physical, social-cultural and policy ractice environments have the potential to influence children’s physical activity (PA) behaviours and weight status. This Australian first study comprehensively examined the association(s) of physical, social-cultural and policy ractice environments with PA, active transport (AT) and weight status among regional primary school children. Data were from two childhood obesity monitoring systems in regional Victoria, Australia. Measured height and weight were collected from students in Year 2 (aged approx. 7–8 years), Year 4 (9–10 years), and Year 6 (11–12 years). Self–reported PA behaviour, including AT were collected from students in Year 4 and 6 and a sub-s le wore an ActiGraph (wGT3X-BT) accelerometer for 7-days. A school physical activity environment audit was completed by the school principal and responses were used to calculate school physical activity environment scores (PAES) and active transport environment scores (ATES). Mixed effects logistic regression was used to assess the relationship between the proportion of students meeting the PA guidelines (≥60mins/day of moderate-to-vigorous PA) and PAES tertiles (low, medium, high) and those using AT and school ATES tertiles, controlling for gender, school size/type and socioeconomic composition. The analysed s le included 54/146 (37%) schools and 3360/5376 (64%) students. In stratified analysis, girls in schools with a medium PAES score were more likely to meet the objectively measured PA guideline compared to low PAES score (OR 2.3, 95%CI 1.27, 4.16). Similarly, students in schools with a medium or high ATES score had higher odds of self-reported AT (medium OR 3.15, 95%CI 1.67, 5.94 high OR 3.71, 95%CI: 1.80, 7.64). No association between PAES or ATES and weight status were observed. Self-reported AT among boys (OR 1.59, 95%CI 1.19, 2.13) and girls (OR 1.56, 95%CI 1.08, 2.27) was associated with higher odds of meeting self-reported PA guidelines on all 7-days than those who did not report using AT. In this study of regional Victorian primary schools, PA environments were only associated with girls’ adherence to PA guidelines. School AT environments were strongly associated with students’ AT behaviours and with increased likelihood of students being physically active.
Publisher: Springer Science and Business Media LLC
Date: 10-09-2022
DOI: 10.1186/S12966-022-01363-4
Abstract: Participatory approaches to develop community-based system dynamic s models to tackle complexity are promising , but research is needed in how simulation models can be developed with community stakeholders to yield significant system insights. This study presents the results of a community-based system dynamics modelling process to increase water consumption and decrease sugar sweetened beverage consumption in Portland, Victoria, a regional town in Australia. A series of group model building workshops with 11 community stakeholders addressing the topic of water and sugar sweetened beverage consumption was conducted in Portland. A simulating system dynamics model was built with stakeholders to inform action planning. A system dynamics model was created to provide insight into water and sugar sweetened beverage consumption in Portland. The model included six feedback loops describing the causal effects of sugar sweetened beverage consumption habits and norms, water taste, water consumption norms, public water availability, and public health benefits. For ex le, the sugar sweetened beverage consumption norm loop modelled how people overestimating others’ consumption may motivate an increase in their own consumption, feeding back and further lifying an increase in sugar sweetened beverage consumption. The model contributed to the foundation of a strong partnership to improve the taste of water and educate the public on water consumption. Engaging stakeholders in system dynamics modelling about water and sugar sweetened beverage consumption increased engagement and collaboration to address the problem among community stakeholders.
Publisher: Mary Ann Liebert Inc
Date: 07-2023
Publisher: Public Library of Science (PLoS)
Date: 11-05-2022
DOI: 10.1371/JOURNAL.PONE.0266654
Abstract: Community-based interventions have shown promise in reducing childhood overweight and obesity. However, they have been critiqued for using linear logic models. Participatory community-based systems approaches are posited as addressing the complexity of non-linear relationships in a local context. Community members are empowered to understand and describe obesity causation, identify and prioritise possible solutions. The application of such approaches to childhood obesity is in its infancy. To describe the first 12 months of a participatory whole-of-community systems approach to creating collective action to tackle childhood obesity, called GenR8 Change, in a local government area of Victoria, Australia. Three group model building (GMB) sessions focused on the development of a causal loop diagram (CLD), prioritised evidence-informed actions, and developed implementation strategies. The collective impact framework underpinned the approach, with a local backbone group supporting community members to implement prioritised actions. The first two GMB sessions included 20 key community leaders where a CLD examining the factors contributing to childhood obesity in the community was constructed and refined (22 variables GMB1, 53 variables GMB2). In the third session, 171 members of the wider community further refined the CLD, identified priorities for childhood obesity prevention (72 variables in final CLD). One-hundred and thirteen in iduals signed up across 13 working groups to plan and implement 53 prioritised actions. Agreed community actions included creating sugar free zones developing healthy policies increasing breastfeeding rates improving drinking water access and increasing physical activity options. Twelve months post-GMB3, 115 actions had been implemented. GenR8 Change is one of the first communities to apply systems thinking to childhood obesity prevention. Knowledge on how to collectively identify relevant leverage points to tackle childhood obesity can now be shared with other communities.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2022
DOI: 10.1186/S13690-022-00835-0
Abstract: 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. 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 ex les 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. 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. 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. WHO STOPS: ANZCTR: 12616000980437 . RESPOND: ANZCTR: 12618001986268p .
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-068190
Abstract: To present an approach to build capacity for the use of systems science to support local communities in municipal public health and well-being planning. Case study. Local government authorities participating in the VicHealth Local Government Partnership in Victoria, Australia. Local government staff members were trained in community-based system dynamics (CBSD), and group model building (GMB) techniques to mobilise local community efforts. The trained local government facilitation teams then delivered GMB workshops to community stakeholder groups from 13 local government areas (LGA)s. Training in CBSD was conducted with council facilitation teams in 13 LGAs, followed by the local delivery of GMB workshops 1–3 to community stakeholders. Causal loop diagrams (CLD) representing localised drivers of mental well-being, healthy eating, active living or general health and well-being of children and young people were developed by community stakeholders. Locally tailored action ideas were generated such as well-being classes in school, faster active transport and access to free and low-cost sporting programmes Overall, 111 local government staff participated in CBSD training. Thirteen CLDs were developed, with the stakeholders that included children, young people and community members, who had participated in the GMB workshops across all 13 council sites. Workshop 3 had the highest total number of participants (n=301), followed by workshop 1 (n=287) and workshop 2 (n=171). Local facilitation of the CBSD process has developed community informed and locally relevant CLDs that will be used to lead local action to improve the well-being of children and young people. Training employees in CBSD is one approach to increase systems thinking capacity within local government.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 07-04-2022
DOI: 10.1186/S12913-021-07418-9
Abstract: A large proportion of staff working in hospital settings are overweight or obese, have poor dietary habits and low physical activity levels. The workplace is a priority setting for health promotion. This systematic review will describe dietary and physical activity workplace interventions that have aimed to improve the health of staff in hospital settings and the barriers and enablers of implementing these interventions. A systematic search retrieved 551 studies from 2004 to 2020 using the following databases CINAHL Complete, MEDLINE Complete, Academic Search Complete, Global Health, Health Source Nursing/Academic Edition and PsycINFO. Studies were included if they: (1) took place in a hospital setting (2) employed a physical activity or dietary intervention to improve the well-being of staff (3) the intervention duration was 12 weeks or over (4) used a control group. The Integrated quality Criteria for the Review of Multiple Study designs (ICROMS) and National Institute of Health’s National Heart Lung and Blood Institute Quality Assessment Tools for Observational Cohort and Cross-Sectional Studies tools were used to assess quality of included studies. A narrative review was conducted. Quality analysis identified six studies of high quality, nine moderate quality, and three low quality. Of these 18 studies, 15 reported at least one positive health outcome. The evidence revealed that multi-component strategies, financial incentives and motivational strategies were the most effective approaches to improve health behaviours of hospital staff. Hospital-based dietary and physical activity workplace interventions show promise as an effective strategy for improving health behaviours of hospital staff. Methodological limitations highlight the need for more research from high-quality, randomised control trials, to gain further insight into the benefits of workplace interventions in hospital settings.
Publisher: Public Library of Science (PLoS)
Date: 20-06-2023
DOI: 10.1371/JOURNAL.PONE.0287468
Abstract: Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these ‘shocks’ on the local prevention workforce to implement actions within communities. A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive s ling was used to achieve erse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre’s implementation factors. Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group s le) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not ‘shock proof’.
Publisher: BMJ
Date: 05-2018
Publisher: Wiley
Date: 29-07-2019
DOI: 10.1111/OBR.12865
Publisher: Wiley
Date: 05-05-2021
DOI: 10.1002/OBY.23130
Publisher: Cambridge University Press (CUP)
Date: 13-07-2023
DOI: 10.1017/S136898002300126X
Abstract: Government policy guidance in Victoria, Australia, encourages schools to provide affordable, healthy foods in canteens. This study analysed the healthiness and price of items available in canteens in Victorian primary schools and associations with school characteristics. Dietitians classified menu items (main, snack and beverage) using the red, amber and green traffic light system defined in the Victorian government’s School Canteens and Other School Food Services Policy. This system also included a black category for confectionary and high sugar content soft drinks which should not be supplied. Descriptive statistics and regressions were used to analyse differences in the healthiness and price of main meals, snacks and beverages offered, according to school remoteness, sector (government and Catholic/independent) size, and socio-economic position. State of Victoria, Australia A convenience s le of canteen menus drawn from three previous obesity prevention studies in forty-eight primary schools between 2016 and 2019. On average, school canteen menus were 21 % ‘green’ (most healthy – everyday), 53 % ‘amber’ (select carefully), 25 % ‘red’ (occasional) and 2 % ‘black’ (banned) items, demonstrating low adherence with government guidelines. ‘Black’ items were more common in schools in regional population centres. ‘Red’ main meal items were cheaper than ‘green’% ‘black’ (banned) items, demonstrating low adherence with government guidelines. ‘Black’ items were more common in schools in regional population centres. ‘Red’ main meal items were cheaper than ‘green’ (mean difference –$0·48 (95 % CI –0·85, –0·10)) and ‘amber’ –$0·91 (–1·27, –0·57)) main meal items. In about 50 % of schools, the mean price of ‘red’ main meal, beverages and snack items were cheaper than ‘green’ items, or no ‘green’ alternative items were offered. In this s le of Victorian canteen menus, there was no evidence of associations of healthiness and pricing by school characteristics except for regional centres having the highest proportion of ‘black’ (banned) items compared with all other remoteness categories examined. There was low adherence with state canteen menu guidelines. Many schools offered a high proportion of ‘red’ food options and ‘black’ (banned) options, particularly in regional centres. Unhealthier options were cheaper than healthy options. More needs to be done to bring Victorian primary school canteen menus in line with guidelines.
Publisher: Elsevier BV
Date: 05-2022
DOI: 10.1016/J.AMEPRE.2021.10.006
Abstract: Applying systems science in public health trials is a recent innovation in childhood obesity prevention. This paper aims to use systems science conventions to propose a theory of change for community-based interventions aiming to build capacity and use exemplars from systems science for obesity prevention to describe how this approach works. Participants were community-based researchers. A dynamic hypothesis was created in workshops conducted in 2020 and 2021 by identifying variables critical to building community capacity for systems thinking. These were used to develop stock and flow diagrams representing in idual causal relationships, feedback loops, and the overall theory of change. The resultant model identified 9 stocks and 4 pairs of central balancing and reinforcing feedback loops. These represented building commitment through relationships, mutual learning, strengthening collaboration, and embedding capacity. The model is described using ex les from 3 trials involving 25 communities across Victoria, Australia. This nonlinear and practice-based model illustrates the process of community-based obesity prevention. The model integrates >20 years of community-based intervention implementation experience, providing an overarching theory of how such interventions work to create change and prevent obesity.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 27-11-2021
DOI: 10.1186/S12889-021-12150-4
Abstract: Approximately a quarter of Australian children are classified as overweight or obese. In high-income countries, childhood obesity follows a socio-economic gradient, with greater prevalence amongst the most socio-economically disadvantaged children. Community-based interventions (CBI), particularly those using a systems approach, have been shown to be effective on weight and weight-related behaviours. They are also thought to have an equitable impacts, however there is limited evidence of their effectiveness in achieving this goal. Secondary analysis was conducted on data collected from primary school children (aged 6–13 years) residing in ten communities (five intervention, five control) involved in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) cluster randomised trial in Victoria, Australia. Outcomes included Body Mass Index z-score (BMI-z) derived from measured height and weight, self-reported physical activity and dietary behaviours and health related quality of life (HRQoL). Repeat cross-sectional data from 2015 ( n = 1790) and 2019 ( n = 2137) were analysed, stratified by high or low socio-economic position (SEP). Multilevel linear models and generalised estimating equations were fitted to assess whether SEP modified the intervention effect on the outcomes. There were no overall changes in BMI-z for either SEP strata. For behavioural outcomes, the intervention resulted in a 22.5% (95% CI 5.1, 39.9) point greater improvement in high-SEP compared to low-SEP intervention schools for meeting physical activity guidelines. There were also positive dietary intervention effects for high SEP students, reducing takeaway and packaged snack consumption, although there was no significant difference in effect between high and low SEP students. There were positive intervention effects for HRQoL, whereby scores declined in control communities with no change in intervention communities, and this did not differ by SEP. The WHO STOPS intervention had differential effects on several weight-related behaviours according to SEP, including physical activity. Similar impacts on HRQoL outcomes were found between high and low SEP groups. Importantly, the trial evaluation was not powered to detect subgroup differences. Future evaluations of CBIs should be designed with an equity lens, to understand if and how these types of interventions can benefit all community members, regardless of their social and economic resources.
Publisher: Research Square Platform LLC
Date: 20-08-2020
DOI: 10.21203/RS.3.RS-60864/V1
Abstract: Objectives : To test the effectiveness of the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHOSTOPS) for behavioural, health related quality of life and Body Mass Index (BMI) outcomes. Design :Cluster randomized trial of ten communities randomly allocated (1:1) to start intervention in 2015(step one) or in 2019 (after 4-years). Setting :Community based trial in South West Victoria, Australia, including all major health and local council agencies. Participants : Data were collected from 59 participating primary schools April-June of 2015 (73% school participation rate) 2017 (69%), and 2019 (63%). Student participation rates were 80% in 2015 (1,792/2,516 invited), 81% in 2017 (2,411/2,963), and 79% in 2019 (2,177/2,720). Interventions: Local leaders, organisations and community members developed obesity prevention interventions and implementation measures using a five phase process to change existing conditions that lead to childhood obesity. Main outcome measures: Measured height and weight (Grades two, four and six), self-reported behavioural, and health-related quality of life (Grade four and six). Results: There was an intervention by time interaction in both age and sex standardizedBMI (BMIz) (p=0.031)and obesity/overweight prevalence (p=0.006). The control communities remained unchanged whereas BMIz and overweight/obesity prevalence decreased between 2015 and 2017 and increased between 2017 and 2019 in intervention communities. The intervention reduced take away food consumption (p=0.006) and improved physical (p=0.036) and global (p=0.036) health related quality of life. Water consumption increased among girls (p=0.019)as did energy-dense and nutrient poor snack consumption (p=0.015) and take-away food consumption among boys (p= 0.012). BMIz of the grade two cohort steadily increased. Conclusions : WHOSTOPS had a positive impact on takeaway food intake and health-related quality of life. Trial registration : Australian New Zealand Clinical Trials Registry (ANZCTR): 12616000980437.Registered 26 July 2016 - Retrospectively registered www.anzctr.org.au/Trial/Registration/
Publisher: Cambridge University Press (CUP)
Date: 05-12-2022
DOI: 10.1017/S1368980022002531
Abstract: Childhood obesity prevention is critical to reducing the health and economic burden currently experienced by the Australian economy. System science has emerged as an approach to manage the complexity of childhood obesity and the ever-changing risk factors, resources and priorities of government and funders. Anecdotally, our experience suggests that inflexibility of traditional research methods and dense academic terminology created issues with those working in prevention practice. Therefore, this paper provides a refined description of research-specific terminology of scale-up, fidelity, adaptation and context, drawing from community-based system dynamics and our experience in designing, implementing and evaluating non-linear, community-led system approaches to childhood obesity prevention. We acknowledge the importance of using a practice lens, rather than purely a research design lens, and provide a narrative on our experience and perspectives on scale-up, fidelity, context and adaptation through a practice lens. Communities. Practice-based researcher experience and perspectives. Practice-based researchers highlighted the key finding that community should be placed at the centre of the intervention logic. This allowed communities to self-organise with regard to stakeholder involvement, capacity, boundary identification, and co-creation of actions implemented to address childhood obesity will ensure scale-up, fidelity, context and adaptation are embedded. We need to measure beyond primary anthropometric outcomes and focus on evaluating more about implementation, process and sustainability. We need to learn more from practitioners on the ground and use an implementation science lens to further understand how actions work. This is where solutions to sustained childhood obesity prevention will be found.
No related grants have been discovered for Penny Fraser.