Exploring how to support regional and rural communities with delivering obesity prevention interventions to improve child health.

This pilot trial is a sub-study of the Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) stepped wedge trial. The RESPOND trial seeks to adopt systems change interventions to increase community capacity in the identification and delivery of community-generated systems interventions. The RESPOND trial comprises FIVE components (described in a previous registration ACTRN12618001986268). These are: 1. Systems approach capacity building 2. Community-led intervention activity 3. School Monitoring System and analysis 4. Knowledge and Engagement 5. Collaborative Governance and Implementation Structure (Collective Impact). All communities in the RESPOND trial would receive a series of workshops and support sessions, to identify community-generated systems actions targeting childhood obesity prevention in their community. In addition to this, the four communities in the intervention arm of the current pilot study will receive additional implementation strategies to address specific barriers to implementation at the community level. The implementation strategies will be delivered across six months to the community facilitation team, who consists of health promoters situated in community health services or local councils and other relevant organisations with a prevention role in the local context. The implementation strategies include: a. Prioritisation support to select evidence-based and locally appropriate actions for implementation. This includes a presentation of evidence around the priority action ideas that have been identified by the community using the systems-approach, e.g. establishing a community vegetable garden, the “walking school bus” program and installing new water fountains. The research team will support the facilitation team with prioritising their action ideas, using frameworks such as the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Spill-over effects, Equity) Criteria. Support will also be provided to further refine action ideas to best reflect the evidence and is appropriate for their local context. This will be delivered at the beginning of the 6-month study period to the facilitation team via two sessions. b. Education workshops and resources. At the beginning of the 6-month study period, the research team will deliver a 5-hour workshop to support the facilitation team with implementation. This will include a presentation of research evidence (refer to strategy a), small group refining of implementation action ideas, identification of barriers and enablers to implementation using a systems-mapping process, identification of evidence-based implementation action ideas and development of an action plan (formal implementation blueprint). c. Using systems-processes to identify, map and track implementation actions. Each community will be supported to use systems approaches to identify key levers for implementation, using the Systems Thinking in Community Knowledge Exchange software (STICKE). This software supports the generation of causal maps to guide the facilitation team with thinking about broader determinants to implementation and subsequently move the team into implementation action generation. A research member with extensive experience in systems thinking will demonstrate and support the communities with undertaking this process. This will be delivered as part of the education workshop (strategy b). The facilitation team will also be supported to use STICKE to continue to track changes in determinants and actions across the study period. d. Engaging a local implementation champion (advocate). Each community will be asked to identify an implementation champion at the beginning of the study, who will work with the research team to support the implementation of the prioritised action idea. A brief outline of the roles and responsibilities of the champion will be provided including supporting the development and implementation of an action plan, monitoring and tracking implementation progress. Throughout the study, the Champion will also provide encouragement and support to the broader facilitation team to overcome any barriers that may arise. e. Provide local centralised technical assistance. A research team member with extensive health promotion experience and connection with the local community will touch-base with the implementation champion and/or facilitation team, at up to three occasions during the 6-month study (approx. every 2 months), via online meetings or phone. The main purpose of this session is to review the action plan, support any problem solving, support reflection on the causal maps, action tracking and modifying the action plan if required. An internal study tracking spreadsheet will be used to record dates and attendees of the education workshop and dates and brief minutes of touch-base occasions of each community. Action plans and subsequent changes will be recorded on STICKE. Data collection for this pilot study will be staggered depending on community recruitment and completion of the RESPOND Trial. This study leverages on the completion of RESPOND by incorporating additional implementation strategies and evaluation following the completion of RESPOND.