This section presents a summary of the main evaluation findings in relation to the elements in the RE-AIM framework.
Reach
The Go-Golborne events were attended by over 3360 local children and families, with the most popular events attracting more than 1000 participants. Given the estimate of 900 children living in the ward, and over 1,700 children attending the six primary schools working with the project, this represents excellent reach into the community. Stakeholders praised the diverse range of partners that reflected the local community and offered greater relevance and reach. The involvement of all six primary schools enabled access to a large number of local children and families. Children and parents also engaged with Go-Golborne at after-school clubs and holiday activities. Parents with pre-school children had less contact with the programme content, though some recognised the logo through posters in the Children’s Centre or park events.
Efficacy
Qualitative data suggested that children’s knowledge about healthy foods improved over the course of the programme, and they now had an improved capability to make small changes in their dietary choices, where supported. Stakeholders had noticed positive changes in knowledge/awareness amongst children, particularly related to certain Go-Golborne campaigns.
“I think it's had a really positive impact on the community; … children are more aware of their healthy eating choices, they are aware of what they should eat and shouldn't eat”. (Statutory partner, interviewed 2017)
“My children… they love all the projects and they came home and kept talking about it and my son was like, 'oh mummy I'm not having a doughnut, because it contains so much sugar!'”. (Parent, interviewed 2017)
Key messages around physical activity do not appear to have been absorbed so readily by the children. There was a greater sense of decisions being outside of the children’s control:
“… sometimes there’s good stuff going on but then if you are busy or like I have younger brothers then you can’t always go” (Child in Focus Group Discussion, 2018).
Parents reported that Go-Golborne had raised awareness of healthy eating and activity in a fun and enjoyable way, and had provided them with greater motivation to further support healthy choices for their children. The follow-up parent questionnaires, however, did not suggest an improvement in knowledge around key health-related recommendations.
Data from partners, parents, teachers and children appeared to suggest that attitudes amongst children and parents were shifting. Quantitative data gathered via the Child Nutrition Questionnaire (CNQ) (for years 5-6, N=1692) identified a positive shift in attitudes (i.e. lower value scores on CNQ) towards eating fruit and vegetables across the four year period. The relationship between cohort and attitudes towards vegetables showed significant variance in intercepts across participants, var(u0j) = 2.65, X2 (9) = 130.18, p<.01. Results from the LMM suggest that attitudes in 2019 (M = 6.56, SD=3.70) towards vegetables improved compared to at the start of Go-Golborne in 2016 (M = 15.17, SD=3.58), F(3,778.77) = 236.14, p<.01, (CI 95% = 4.89, 5.83).
The relationship between cohort and attitudes towards fruit also showed significant variance in intercepts across participants, var(u0j) = 3.54, X2 (9) = 184.12, p<.01. Results from the LMM suggest that attitudes in 2019 (M = 6.64, SD=3.08) towards fruit improved compared to levels in 2016 (M = 17.53, SD=3.08), F(3,721.16) = 1201.94, p<.01, (CI 95% = 9.95, 10.76).
The child questionnaire did not collect information on attitudes towards physical activity (due to the need to keep the length manageable), but rather focused on measuring changes in behaviour. Qualitative data highlighted that children associated physical activity with having fun and socialising with friends, rather than ‘being healthy’. However, having fun and socialising was also closely linked to the use of electronic devices. Other children, who appeared to enjoy more physical activity, pointed to the barriers to taking part and the lack of opportunities, both in school and out.
Partners reported that their collaboration with Go-Golborne improved their reach into schools or community settings, increased the creativity and relevance of the messages they delivered, and linked the campaign messages to their own frameworks. They reported making many useful new contacts, and benefiting from participating in Go-Golborne events through an increased awareness of local services. Responses to the stakeholder questionnaire highlighted, for example, new collaborations between different organisations and groups. Training provided by the programme enabled local staff members to feel more confident in delivering consistent messages about health and weight when working with families. Most partners felt the programme improved their ability to support healthy lifestyles in the community, e.g. through developing new skills or knowledge around supporting children and families.
A large proportion of parents responding to the 2019 questionnaire reported making positive changes to improve their children’s diet, increase the amount of physical activity, and decrease the amount of screen time their children engaged in. For example: 49% of parents responding to the survey reported making changes to reduce sugar (with cutting down on sweets and/or sugary snacks and having smaller portions of sugary foods/drinks being the most frequently cited examples), 56% to reduce salty/fatty snacks and 60% to increase fruit and vegetable consumption; 46% of parents reported making changes to be more active in travel to/from school; and 50% of parents reported making changes to reduce screen time. Partners and teachers reported seeing some of these changes beginning to happen, although they highlighted that there was still much progress to be made, that some families needed more support than others, and that there was a need to keep the momentum going.
Schools and local community venues/services were starting to make positive changes to support healthier diets and activity. Many different examples of changes were mentioned by organisations, including swapping the snacks and drinks provided for healthier alternatives, promoting healthier vending machines, organising and promoting walks and bike rides, creating and promoting new ways of encouraging active play, and running non-screen sessions during holiday times. Children, parents and partners referred to the changes that they had seen in local shops and venues, with, for example, some noticing a shift towards healthier options being available in shops and greater visibility of fruit and vegetables at street level. Teachers also detailed the continued and additional ways in which they were making healthier choices easier in school by, for example, having easy access to drinking water, offering active after school clubs, and proving fruit/vegetable snacks to key stage two pupils. These positive changes were being noticed by parents, with the majority of those responding to the 2019 survey agreeing that their child’s school actively supports healthy eating and active movement.
In the second stakeholder questionnaire, partners described a higher uptake of local activities – both those facilitated by their own organisation and those in other settings (e.g. local leisure centres), and there were increased referrals to child healthy weight services.
Across the six behaviour change themes, there was little quantitative evidence from the surveys of positive, sustained shifts in children’s behaviours. Most behaviours fluctuated across the four cohorts. The parent questionnaires also confirmed that there was much progress to be made in improving children’s behaviours to meet recommended levels. For example, in 2019, 65% of responding parents thought their child ate fewer than the recommended 5 a day; only 16% of parents said their child took part in vigorous activity on five days or more; and 27% of parents reported that their youngest child engages in two or more hours of screen time on a typical school day (60% on a typical weekend day). The behaviour change data is reported in full elsewhere (in progress).
However, qualitative data suggested some positive shifts in behaviours. For example, partners reported that parents no longer brought sweet snacks or drinks to the activity sessions; and local shops and businesses reported fewer children buying sweets where partners had banned unhealthy snacks.
The data collected on children’s heights and weights indicated that the proportion of children in the ‘healthy weight’ category (according to BMI centiles) remained stable, with no statistically significant change over the four-year time period. The proportion of children in the ‘overweight’ and ‘very overweight’ categories also remained stable over time.
Adoption
The Go-Golborne partnership comprised 110 organisations and businesses, including schools, nurseries, community centres, mosques, market traders and corner shops. A small core of partners (six to nine organisation representatives, including a local councillor) met as the Steering Committee eight times during the programme. A larger stakeholder group, averaging 25 attendees, met ten times during the programme. In total, over 100 stakeholder partners representing at least 62 organisations attended at least once. Organisations included those from the third sector, Council departments, health and leisure partners and others, which brought a diversity of local knowledge, contacts and expertise to the table. Partners were also engaged through training sessions, small grants delivery, use and dissemination of resources, and in the planning and delivery of events. Between six and 25 agencies were involved in each of the community events. Further details of key programme activities and their uptake are provided in Table 1. This highlights a high level of adoption within the community by a wide range of partners who interact with children and families.
Table 1: Description of Go Golborne community activities involving local partners
Activity
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Details
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Uptake
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Stakeholder meetings
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10 quarterly stakeholder meetings to plan, reflect, evaluate and report work, and invite input from partners.
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Over 100 partners attended from over 62 organisations.
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Training for partners
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Six tailored training sessions delivered on: healthy eating and nutrition; physical activity and play; nutritional guidelines and cooking on a budget; active health and delivering physical activity; sugar smart ‘train the trainer’; being a walk leader.
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Between eight and 22 participants attended from a range of organisations.
At least 75 partners took part overall.
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Events
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Seven community events aligned with the campaigns with a fun community focus.
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An average of:
26 partners involved in event planning; 19 involved in delivery.
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Campaign resources
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Go Golborne created 46 different project resources and distributed 76,000 items to children and families.
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All partners received the resources for information and distribution. Eight out of 10 partner survey respondents said that they distributed resources to their service users.
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Campaign Grants
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Grants of up to £2000 available to local partners to deliver community activities and/or for organisational development.
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52 grants were distributed to local partners, including primary schools. Four out of 10 partner survey respondents had applied for and received a grant.
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Work with primary schools
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Delivery of healthy lifestyle messages (e.g. through facilitated assemblies and sharing of resources) and support to strengthen school practices and policies
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All six local primary schools engaged; four schools received a total of seven grants. Five achieved Healthy Schools awards and two worked with MyTime Active who delivered activity workshops for students.
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Strengthening the food environment
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Local partners and businesses supported to develop healthy policies and practice through campaigns and partnership.
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40 partners made pledges to be more Sugar Smart; 10 pledged to make organisational or policy changes. 77 businesses achieved a Healthier Catering Commitment award. Environmental Health piloted additional sugar-smart criteria with seven businesses as part of their Heathy Catering award scheme.
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Extension projects (commissioned work)
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Shop Healthy Golborne: Rice Marketing worked with local traders to audit, position and promote healthier products
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Three local convenience stores participated. They introduced 77 new healthier lines and actively promoted them.
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Fit for Kids: Health Education Partnership developed a kitemark system for community organisations to develop best practice in promoting healthy lifestyles.
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Three organisations piloted the programme. One achieved the award, others provided valuable feedback to improve the tool. Two more organisations were subsequently working towards the award.
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Implementation
The six themed community-wide social marketing campaigns formed the backbone of Go-Golborne’s multi-strategy approach. Around this backbone, implementation was flexible to adapt to changing circumstances and to lessons learned. This adaptability proved to be of crucial importance: first, when due to cut-backs five months in, programme staffing was significantly reduced (the full-time communication and engagement officer was cut to minimal communications support), and second, when in June 2017, the Golborne community was rocked by the tragic fire at the neighbouring Grenfell Tower. The event and its aftermath traumatised members of the local community, stretched local services, took a great deal of focus and attention, and damaged relationships, particularly between the community and the Council. The Go-Golborne staff were extremely sensitive to this context. Despite some inevitable implications for programme delivery, all the campaigns largely ran as anticipated. Information was disseminated via 76,000 original health promotion resources; the majority of partners found the information to be highly trustworthy, relevant and useful. The seven community events were widely supported by partners and attended by the local community. The campaigns generated positive messages to which stakeholders and community members responded well. Training was delivered to over 75 local staff/volunteers, with consistently high feedback. Many opportunities were provided for network-building and partnership development. Twenty-six partners received 52 Go-Golborne grants to deliver activities related to the campaigns, and four schools used grants for theme-based activities. Stakeholders reported that Go-Golborne was responsive to local concerns, and aligned itself with existing/similar services and programmes, reducing the potential for overlap or unnecessary additional work, and helping to ensure that involvement was a positive experience.
Maintenance
Relationships forged in the early days of the programme were actively maintained throughout. The staggered delivery of the campaigns helped to ensure that partners could be engaged in each different theme, helping to keep their interest in the programme overall. Existing infrastructures were built on for programme delivery and programme actions were integrated into the practice of partner organisations. The collaborative way in which campaign messages and resources were designed and delivered helped to ensure that they became embedded within the minds of many key change agents (such as those working with children). Partners explained that the programme resources will continue to be used and the knowledge and connections made during the programme will continue to be valuable. The emphasis on simple messages, and realistic, achievable ideas increased the likelihood that elements of the programme would be embedded into routine practice. As these partners commented:
“The culture of our organisation is starting to shift slowly towards understanding and enabling healthier choices” (Local voluntary sector partner, partner survey 2016)
“We’re going to maintain these things; we’re not going to change anything. I took all [the Go Golborne] banners, and we’ve got the Unplug and Play poster out in the playground as a constant reminder and [the programme has] left a legacy because we have all these great things in place. So like with me, I campaign for public health, for children’s health, so it will always be on the top of my agenda when it comes to outcomes for children – it will always stay, it’s fixed” (Go-Golborne Partner, interviewed 2018).
“I think it’s sustainable because it’s not too straining on the schools to keep doing it … I think that it’s a good thing to do” (Teacher, interviewed 2018).
As shown in Table 1, many activities, particularly around improving the food environment, prompted partners to implement changes in routine organisational practices and policies.