Evidence Based Planning

Overall objective: To conduct and disseminate to public health practitioners and policy makers, reviews of scientific evidence, combined with expert advice from experience in the field, to identify policy and program options that show promise for achieving population changes in dietary behaviours.

Planning and managing nutrition programs, to achieve better outcomes, is both and art and a science. Using available evidence appropriately to plan strategies and programs to improve population nutrition improves the science base of programs and the chances of “doing the right thing”. Use of the best research evidence, together with lessons from experience, improves the likelihood that:

• The right dietary factors are identified for change in program objectives;
• The most important determinants of the dietary factors will be selected for attention;
• The groups most in need of change in these factors will be targeted;
• Interventions or programs which address the planned objectives, the determinants and the target group, are likely to achieve the objectives (or show promise in doing so)

The Centre assists the public health workforce to use evidence and the wisdom of others’ experience in planning local and state policies and programs, coordinated with and complementary to, national policies and strategies.

The Centre continues to liaise with NSW Health and Area Health services to assist with strategic and operational planning, particularly with the tasks of priority setting and selection of strategies. In accordance with this, the Centre regularly produces documents and reports to assist with evidence-based planning of public health nutrition interventions in NSW. For these reports the Centre conducts literature reviews and audits current and recent programs and activities to highlight examples of promising interventions in the priority areas identified in Eat Well NSW are:

• Promoting healthy weight
• Promoting increased consumption of fruit and vegetables
• Promoting breastfeeding
• Achieving improved food security
• Achieving effective and sustainable action in public health nutrition.

All of the Centre’s evidence-based panning documents support the Eat Well NSW 2003-2007 priority area ‘Achieving effective and sustainable action in public health nutrition’.

NSW Nutrition Strategy: Eat Well NSW 2003-2007 (2003-04; Karen Webb, Tim Gill)

The Centre was involved in the background work for and prepared the first draft of the NSW Nutrition Strategy Eat Well NSW: Strategic Directions for Public Health Nutrition 2003 – 2007 (www.health.nsw.gov.au/pubs/e/pdf/eatwellnsw.pdf)

This directive provides a clear statement of health sector priorities for public health nutrition in NSW. Its purpose is to guide measurable population food and nutrition improvements.

PROMOTING BREASTFEEDING

Overview of interventions to promote and support breastfeeding (2004; Debra Hector, Lesley King, Karen Webb)

This report summarised the evidence from nine systematic reviews of interventions to promote breastfeeding. It aimed to assist health professionals in NSW in planning selected types of policies and programs to promote and support breastfeeding. The report appraised the range of the evidence; identified a substantial body of evidence that provided a sound basis to proceed with evidence-based programs and practices in a number of areas, particularly those areas addressed by mainstream health services; and identified gaps in the evidence base.

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Promoting and supporting breastfeeding in NSW: Case studies (2005; Lesley King, Debra Hector, Karen Webb)

This report was intended to supplement the overview report. It presents 31 case studies to illustrate potentially effective strategies and interventions to promote and support breastfeeding under three strategy areas: education and support; health service policies and practices; mass media, advocacy and healthy public policy. It contains more detailed descriptions of specific interventions found to be effective in systematic reviews and also illustrates a range of initiatives related to strategies and intervention points not covered in systematic reviews. Case studies were selected to present a range of strategies, to be relevant to the NSW context, and where there was some evidence the intervention was effective or promising.

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NSW Health Breastfeeding Policy (2005-2006; Deb Hector: member of working group)

Debra Hector was an integral member of the working group and contributed substantially to ensuring the evidence-based objective of this Policy. The Policy was developed by Edwina Macoun (NUPA Public Health Nutrition Program Coordinator, NSW Health) and Ruth Worgan (NSW Breastfeeding Project Coordinator) with assistance from other working group members:

• Louise Duursma (Australian Breastfeeding Association NSW)
• Sophie Erzay (Aboriginal Health and Medical Research Council)
• Joy Heads (Australian Lactation Consultants Association, NSW)
• April Hyde (Senior Policy Analyst, Child and Family Health, NSW Health)
• Gwen Moody (Child and Family Health Nurses Association, NSW)
• Beth Stickney (South East Sydney & Illawarra AHS)
• Rachel Sutherland (NSW Nutrition Network)

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PROMOTING HEALTHY WEIGHT

Building Solutions for Preventing Childhood Obesity

A series of modules ‘Building Solutions for Preventing Obesity’ have been produced The Centre has been involved in a collaborative project with the other two Prevention Research Centres (NSW Centre for Overweight and Obesity and the NSW Centre for Physical Activity and Health) in the development of a set of resources that provide up-to-date and solution-oriented information to guide the development and implementation of child obesity prevention strategies in NSW. This series of modules synthesises recent evidence of the effectiveness of interventions for preventing weight gain and promoting healthy weight among children and adolescents. The modules have been designed to meet the needs of relevant policy-makers, government agencies, area health service workers, non-government and community organisations, and health practitioners. The modules relating to specific dietary behaviours are indicated below.

Best options for promoting healthy weight and preventing weight gain in NSW (2003; Tim Gill, Lesley King, Karen Webb)

This report focuses on prevention and applies a structured planning framework as the basis for proposing the adoption of multi-faceted interventions at the local level and a broad portfolio of actions at the state level. It synthesises findings from published studies of evidence on the effectiveness of different interventions but adopts a broader approach to evidence of effectiveness. It follows the portfolio model proposed by Hawe and Shiell (1995) which allows the selection of interventions to be based on the best available evidence, whilst not excluding untried but promising strategies. This approach has particular appeal for the selection of the best options for the prevention of weight gain and promotion of healthy weight because of the limited body of well conducted and evaluated studies. On this basis, the report considers the level of potential health gain and level of uncertainty or risk associated with different interventions, as a basis for decision-making about programs, and adopts the concept of ‘promising’, to allow a more accurate description of the judgements that are being made. It is proposed that the term ‘promising’ presents the suggestion that an intervention is deemed worthy of systematic implementation and evaluation. In this approach, the basis for expectations explicitly involves consideration of effectiveness, appropriateness and feasibility.

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Healthy Weight for Adults and Older Australians (2005-2006)

A Commonwealth Department of Health & Ageing funded project: A review of the evidence for interventions and the development of a framework for interventions to address overweight and obesity in adults and older people, with specific reference to people living in rural and remote Australia and Aboriginal and Torres Strait Islanders.

Investigators were the NSW Centre for Overweight and Obesity, Centre for Physical Activity and Health, and the NSW Centre for Public Health Nutrition, in collaboration with the Collaborative Centre for Aboriginal Health Promotion, Centre for Rural Health (Broken Hill) and University of Queensland.

The literature review component of this project has been published on the website of the Australian Department of Health and Ageing:

A Literature Review of the Evidence for Interventions to Address Overweight and Obesity in Adults and Older Australians (with special reference to people living in rural and remote Australia and Aboriginal and Torres Strait Islanders) (External link to view paper)

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Review of Interventions Studies (2004)

Gill T, Bauman A, Rychetnik L, Lui B, Hector D, Miller Y, King L. (2004) Detailed review of intervention studies: How do we best address the issues of overweight, obesity and cardiovascular disease? Report prepared for the National Heart Foundation of Australia.

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PROMOTING INCREASED CONSUMPTION OF FRUIT AND VEGETABLES

Background paper – Selecting interventions to promote vegetable and fruit: summary of current resources (2002)

A brief description of some key resources and tools that are being used to promote vegetables and fruit consumption in Australia

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Achieving Improved Food Security

Food Security Options Paper: A planning framework and menu of options for policy and practice interventions (2003; Lucie Rychetnik, Karen Webb, Liz Story, Tamarah Katz)

The objectives of the food security options paper are as follows:

• Define food security/insecurity, and describe the nature of the problem of food insecurity in Australia and overseas
• Develop and present a framework of food security that identifies the important determinants of food security (as related to food supply and access to food)
• Describe the relations between the food and nutrition system; the capacity of individuals or households to acquire food; and the social and economic determinants of health
• Use the food security framework to identify points of intervention for improving food security; and to organise and present intervention options
• Identify examples of each type of intervention, and guide readers to sources of further information on these examples
• Select intervention examples that encourage collaboration between nutritionists and those working to address health inequities; and consideration of inter-sectoral and multi-strategy intervention options
• Provide background information on recent developments in public health policy and practice to address the social and economic determinants of health and inequities in health.

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