Student: Alasdair Duncan
Supervisors: Professor Ann Richardson and Dr Lisa Fitzgerald [Dept Public Health & General Practice]
Sponsor: Canterbury Medical Research Foundation
Healthy Christchurch is a coordinated partnership between various organisations representing a wide range of sectors, including health, government and non-government, business, education, social services. It is based on the World Health Organization's (WHO) Healthy Cities concept, and aims to encourage relationships and information sharing between organisations for the development and implementation of successful health promotion initiatives. There are currently over 200 organisations involved who have signed a charter agreeing to work together to promote, protect and improve the health and wellbeing of the people of Christchurch. In November 2005, the Healthy Christchurch signatories agreed on two priorities: (1) to reduce inequalities in health status by working to improve the health of those in Christchurch who are worst off, and (2) to improve the nutrition and physical activity levels of those living in Christchurch. Following this, Healthy Christchurch requested the Department of Public Health and General Practice Health Technology Assessment Unit to carry out a literature search to identify papers and reports about health promotion programmes designed to reduce inequalities by focusing on physical activity and nutrition.
The aim of this summer studentship was to assess the papers and reports identified in the literature search, and identify well-designed and effective programmes relevant and potentially feasible for Healthy Christchurch signatories to implement. Titles and abstracts were screened for interventions that could be adopted by Healthy Christchurch signatories, and were included for review if: (1) main outcome included physical activity; (2) based in an urban setting; and (3) published after January 1, 1996. The quality of the study designs and the methods used were assessed with a “critical appraisal” checklist, which is a benchmark standard against which other studies can be compared. Due to the major differences in the study designs identified, and the diversity of the outcome measures used, no attempt was made to calculate a quantitative summary. Interventions were determined effective when assessed as high quality following the methodological quality assessment and demonstrated a statistically significant positive effect in one or more outcome measures. Feedback was sought from the Healthy Christchurch coordinator and signatories to validate the relevance and feasibility of the interventions. The manager to the Public Health Intelligence Team (PHIT) then assessed the interventions to ensure they were not currently implemented or in development.
Six high-quality and internally valid interventions were identified, receiving positive feedback from the Healthy Christchurch Co-ordinator, and confirmation from the PHIT manager that they were not currently in development or implemented in the Christchurch setting. Five of these studies showed relevance to Healthy Christchurch signatories whose core business is in the area of physical activity and nutrition. Only one study was identified as relevant to signatories whose core business does not involve physical activity and nutrition, but who would like to make programmes available for their staff and/or clients.
Despite the positive feedback from the Healthy Christchurch coordinator and the PHIT manager, no feedback was received from any of the Healthy Christchurch signatories. Further efforts to gain signatory feedback are required before action is taken to develop any of the initiatives identified. The use of Hui by Healthy Christchurch to communicate directly with signatories has proved popular in the past, and inclusion of the details of this review in future Hui may aid the dissemination of the information and provide a vocal forum for discussion. Due to the major differences in the design, setting and outcome measures of the studies reviewed, only limited conclusions can be drawn about the effectiveness of individual components of the interventions. Further studies should provide greater detail of the components of the interventions, and address the methodological limitations highlighted in this review. It is recommended Healthy Christchurch: (1) Seek details of the components of the interventions identified from the study authors; (2) Develop and implement further efforts to gain signatory feedback, such as a Hui; and (3) Review the awareness, use and effectiveness of the Healthy Christchurch Information Base.