Let's Shape Up! Inspire your Tribe to reduce obesity

Aim

Let's Shape Up! (LSU) aimed to unleash the potential of community-wide tribal leaders to collectively expand their scope of practice to activate the rural and remote population across Mackay Hospital Health Services (MHHS) to engage in evidence-based interventions. These interventions address environmental, socio-cultural and behaviour changes to improve healthy eating and active living. Vulnerable groups and at-risk communities are priorities. LSU was aligned with Queensland and Australian goals for obesity and chronic disease prevention.

Benefits

Obesity has the potential to overwhelm health systems and economic security. The NHF "couch potato" index listed Mackay as fifth in Australia for inactivity, obesity and chronic disease.

Collectively, the activation and accelerated resulting from LSU are building community capacity and changing the socio-cultural norms and environmental supports for Mackay HHS residents towards healthier eating and more active living, to enable long term sustained behaviour change.

Background

Using social inclusion, patient activation and behavioural economics theories and nudge concepts, a tribal approach was adopted to guide community activation by using key social influencers and opinion leaders to encourage and support their tribes and networks toward behaviour change, while enhancing the environmental supports and building sociocultural norms to increase healthy eating and active living.

Evaluation and results

LSU developed a high-functioning and dynamic partnership, which activated tribal leaders to initiate new interventions and accelerated population participation in existing and new interventions. 

The Australian Centre for Health Services Innovation (AusHSI) evaluation (December 2018) concluded:

• Partnership based on genuine collaboration was established, with high confidence in the need for the partnership and focused on common interests, clear goals, partner sharing and commitment, and cost-benefit of the partnership.
• Strong community collaborative was developed, awakening the community to the obesity problem and the innovation, establishing partnerships and engaging stakeholders and tribal leaders. A large (175) and diverse number of partners and tribal leaders were recruited, with more than 90 organisations or groups engaged.
• More than 15,000 people directly engaged in over 42 diverse activities.
• More than $160,000 in-kind contributions received from partners and tribal leaders.
• The Ernst and Young June 2018 economic evaluation of LSU long-term outcomes, including the case for expansion and scalability, recommended proceeding with scalability based on a solid Return-on-Investment of reduced rate of obesity-related hospitalisations within 3 to 5 years, with potential break-even by the third year.
• Accelerated implementation and uptake of obesity prevention programs include:
  • Queensland Health funded programs of My Health for Life, Deadly Choices and 10,000 Steps.
  • Locally funded programs and events by North Queensland Primary Health Network (NQPHN), Councils, workplaces, professional and community groups.

Examples:

My health for Life - Compared to other state electorates in north Queensland and based on population numbers, MHHS had at least triple the rate of risk assessments and double the rate of enrolment and commencement of the program.

10,000 Steps - First Queensland inter-HHS competition undertaken, with 392 kgs and 355 waist cm lost, and 265 million steps taken.
Closing the Gap for Indigenous Australians - The motto "Inspire Your Mob" and specific interventions were developed, resulting in increased participation in GP consultations connected to Closing the Gap (based on ATSICH-derived anecdotal evidence).

National Heart Foundation - Women Who Walk and Men Too has 480 members, the largest NHF walking group in Australia by registrations.
Mackay Regional Council - More than 30 Try The 5 supported events, with more than 600 people attending and 300 competition entries; BMA Marina Run had an increase of 10 percent on previous year's numbers, with 3362 participating.

Jamie Oliver's Ministry of Food NQPHN - 347 participants commenced and 91% completed (above average rate).

Lessons learnt

A tribal approach activates the population to accelerate implementation and participation in obesity reduction interventions.

The AusHSI evaluation noted the need for LSU to work as broadly across the three regions, utilizing coordinated and strategic leadership with strong and transparent governance structures, and develop shared measures of collective success.

These issues have been addressed. The LSU Shared Measurement Framework has been developed with KPIs for the six goals, targets for key KPI measures and measures to monitor population, participant and environmental outcomes and project implementation. The 2017-18 baseline report is under development.

Applied digital technology is required to unleash the full potential of LSU. A dynamic customised platform will be developed to connect all regional programs and tribal initiatives, creating a virtual ecosystem for health and wellbeing for all community members “a whole of community Go To" platform.