Introduction. Interest has grown in how systems thinking could be used in obesity prevention. Relationships between key actors, represented by social networks, are an important focus for considering intervention in systems. Method. Two long day care centers were selected in which previous obesity prevention programs had been implemented. Measures showed ways in which physical activity and dietary policy are conversations and actions transacted through social networks (interrelationships) within centers, via an eight item closed-ended social network questionnaire. Questionnaire data were collected from (17/20; response rate 85%) long day care center staff. Social network density and centrality statistics were calculated, using UCINET social network software, to examine the role of networks in obesity prevention. Results. “Degree” (influence) and “betweeness” (gatekeeper) centrality measures of staff inter-relationships about physical activity, dietary, and policy information identified key players in each center. Network density was similar and high on some relationship networks in both centers but markedly different in others, suggesting that the network tool identified unique center social dynamics. These differences could potentially be the focus of future team capacity building. Conclusion. Social network analysis is a feasible and useful method to identify existing obesity prevention networks and key personnel in long day care centers. 1. Introduction Obesity prevention efforts in childhood are needed to arrest the increasing prevalence of obesity [1–3] and its associated health risks [4]. Children’s food preferences and eating patterns developed by early exposure to foods [5], along with physical activity and inactivity behaviors, have been shown to track from childhood into adulthood [6]. Regulated center-based childcare (such as long day care) may provide an opportune setting for promoting obesity preventing behaviors in preschool children [7, 8]. A systematic review in 2010 of interventions in childcare settings described one third of the studies as promising in improving children’s dietary and/or physical activity behaviors [9], whereas a systematic review in 2011 of interventions in early childhood was critical of current intervention design concluding that social and environmental factors were not given adequate consideration within intervention design and implementation [10]. Those who critique intervention design argue that interventions to tackle childhood obesity must consider a complex system of individual, social, and environmental
References
[1]
L. L. Birch and A. K. Ventura, “Preventing childhood obesity: what works,” International Journal of Obesity, vol. 33, supplement 1, pp. S74–S81, 2009.
[2]
Y. Wang and T. Lobstein, “Worldwide trends in childhood overweight and obesity,” International Journal of Pediatric Obesity, vol. 1, no. 1, pp. 11–25, 2006.
[3]
Y. C. Wang, C. T. Orleans, and S. L. Gortmaker, “Reaching the healthy people goals for reducing childhood obesity: closing the energy gap,” American Journal of Preventive Medicine, vol. 42, no. 5, pp. 437–444, 2012.
[4]
J. Baird, D. Fisher, P. Lucas, J. Kleijnen, H. Roberts, and C. Law, “Being big or growing fast: systematic review of size and growth in infancy and later obesity,” British Medical Journal, vol. 331, no. 7522, pp. 929–931, 2005.
[5]
L. L. Birch and J. O. Fisher, “Development of eating behaviors among children and adolescents,” Pediatrics, vol. 101, no. 3, pp. 539–549, 1998.
[6]
A. M. Craigie, A. A. Lake, S. A. Kelly, A. J. Adamson, and J. C. Mathers, “Tracking of obesity-related behaviours from childhood to adulthood: a systematic review,” Maturitas, vol. 70, no. 3, pp. 266–284, 2011.
[7]
K. M. Kaphingst and M. Story, “Child care as an untapped setting for obesity prevention: state child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States,” Preventing Chronic Disease, vol. 6, no. 1, p. A11, 2009.
[8]
M. E. McGrady, M. J. Mitchell, S. N. Theodore, B. Sersion, and E. Holtzapple, “Preschool participation and bmi at kindergarten entry: the case for early behavioral intervention,” Journal of Obesity, vol. 2010, Article ID 360407, 6 pages, 2010.
[9]
K. D. Hesketh and K. J. Campbell, “Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature,” Obesity, vol. 18, supplement 1, pp. S27–S35, 2010.
[10]
L. Monasta, G. D. Batty, A. Macaluso et al., “Interventions for the prevention of overweight and obesity in preschool children: a systematic review of randomized controlled trials,” Obesity Reviews, vol. 12, no. 501, pp. e107–e118, 2011.
[11]
T. T. Huang, A. Drewnosksi, S. Kumanyika, and T. A. Glass, “A systems-oriented multilevel framework for addressing obesity in the 21st century,” Preventing Chronic Disease, vol. 6, no. 3, p. A82, 2009.
[12]
P. G. Foster-Fishman, B. Nowell, and H. Yang, “Putting the system back into systems change: a framework for understanding and changing organizational and community systems,” American Journal of Community Psychology, vol. 39, no. 3-4, pp. 197–215, 2007.
[13]
Foresight, “Tackling obesities: future choices—building the obesity system map,” 2011, http://www.bis.gov.uk/assets/bispartners/foresight/docs/obesity/12.pdf.
[14]
K. L. Procter, “The aetiology of childhood obesity: a review,” Nutrition Research Reviews, vol. 20, no. 1, pp. 29–45, 2007.
[15]
D. de Savigny and T. Adam, “Systems thinking for health systems strengthening,” 2011, http://www.who.int/alliance-hpsr/resources/9789241563895/en/index.html.
[16]
NICE, “The effectiveness of whole system approaches to prevent obesity: revised final report,” 2012, http://www.nice.org.uk/nicemedia/live/12109/55091/55091.pdf.
[17]
B. L. Riley, “Dissemination of heart health promotion in the Ontario public health system: 1989–1999,” Health Education Research, vol. 18, no. 1, pp. 15–31, 2003.
[18]
R. A. Hanneman and M. Riddle, “Introduction to social network methods,” 2011, http://faculty.ucr.edu/~hanneman/nettext/.
[19]
S. Wasserman and K. Faust, Social Network Analysis: Methods and Applications, Cambridge University Press, New York, NY, USA, 1994.
[20]
T. L. Wiemken, J. A. Ramirez, P. Polgreen, P. Peyrani, and R. M. Carrico, “Evaluation of the knowledge-sharing social network of hospital-based infection preventionists in Kentucky,” American Journal of Infection Control, vol. 40, no. 5, pp. 440–445, 2012.
[21]
D. Meltzer, J. Chung, P. Khalili et al., “Exploring the use of social network methods in designing healthcare quality improvement teams,” Social Science and Medicine, vol. 71, no. 6, pp. 1119–1130, 2010.
[22]
P. Hawe and L. Ghali, “Use of social network analysis to map the social relationships of staff and teachers at school,” Health Education Research, vol. 23, no. 1, pp. 62–69, 2008.
[23]
S. Ramanadhan, J. L. Wiecha, K. M. Emmons, S. L. Gortmaker, and K. Viswanath, “Extra-team connections for knowledge transfer between staff teams,” Health Education Research, vol. 24, no. 6, pp. 967–976, 2009.
[24]
E. a. W. R. Department of Education, “National early childhood development strategy,” 2011, http://www.deewr.gov.au/earlychildhood/policy_agenda/pages/earlychildhooddevelopmentstrategy.aspx.
[25]
A. M. de Silva-Sanigorski, A. C. Bell, P. Kremer et al., “Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program,” American Journal of Clinical Nutrition, vol. 91, no. 4, pp. 831–840, 2010.
[26]
S. P. Borgatti, M. G. Everett, and L. C. Freeman, Ucinet for Windows: Software for Social Network Analysis, Analytic Technologies, Harvard, Mass, USA, 2002.
[27]
P. Hawe, C. Webster, and A. Shiell, “A glossary of terms for navigating the field of social network analysis,” Journal of Epidemiology and Community Health, vol. 58, no. 12, pp. 971–975, 2004.
[28]
R. G. Lee and T. Garvin, “Moving from information transfer to information exchange in health and health care,” Social Science and Medicine, vol. 56, no. 3, pp. 449–464, 2003.
[29]
L. Wolfenden, M. Neve, L. Farrell et al., “Physical activity policies and practices of childcare centres in Australia,” Journal of Paediatrics and Child Health, vol. 47, no. 3, pp. 73–76, 2011.
[30]
S. B. Sisson, J. E. Campbell, K. B. May et al., “Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers,” Journal of the Academy of Nutrition & Dietetics, vol. 112, no. 8, pp. 1230–1240, 2012.
[31]
J. D. Lanigan, “The relationship between practices and child care providers' beliefs related to child feeding and obesity prevention,” Journal of Nutrition Education and Behavior, vol. 44, no. 6, pp. 521–529, 2012.
[32]
F. Lloyd-Williams, K. Bristow, S. Capewell, and M. Mwatsama, “Young children's food in Liverpool day-care settings: a qualitative study of pre-school nutrition policy and practice,” Public Health Nutrition, vol. 14, no. 10, pp. 1858–1866, 2011.
[33]
S. Ramanadhan, J. L. Wiecha, S. L. Gortmaker, K. M. Emmons, and K. Viswanath, “Informal training in staff networks to support dissemination of health promotion programs,” American Journal of Health Promotion, vol. 25, no. 1, pp. 12–18, 2010.
[34]
S. B. Gesell, K. D. Bess, and S. L. Barkin, “Understanding the social networks that form within the context of an obesity prevention intervention,” Journal of Obesity, vol. 2012, Article ID 749832, 10 pages, 2012.
