Health

Public Health: Policy, Principles and Evidence Based Practice

Public health can be defined as ‘the science and art of promoting and protecting health and wellbeing, preventing illness and prolonging life through the organised efforts of society’ (Acheson, 1988, World Health Organisation, 2011). Specialist Community Public Health Nurses (SCPHN’s) perform their duty towards public health in practice by monitoring health and disease conditions, preventing conditions of ill-health and supporting people through life transitions in order to encourage healthier environments(Nursing and Midwifery Council, 2004, Department of Health, 2009). The purpose of this assignment is to provide a Health Needs Assessment and project plan for a defined population with the prioritised health need of childhood obesity. I will outline the evidence based interventions and address the identified needs.

As could be outlined from the research of World Health Organisation Europe (2019), historically, public health practices had not been a priority for the consecutive societies, both at the United Kingdom and beyond. A specific causality of such absence of priority could be understood as the dearth of scientific knowledge concerning the significance of public health management. Thus, various scientific discoveries pertaining to the necessities of public health services and associated practices in the social life, assisted in the heightening of the awareness of the general populace. Two such scientific discoveries could be mentioned in this regard. The first one had been the introduction of vaccination process by Edward Jenner in 1796 (The Health Foundation, 2019). The second one had been the discovery of the significance of hygiene including that of cleanliness through hand washing through the first epidemiological survey conducted by the first epidemiologist John Snow. According to Wright, Williams and Wilkinson (1998), the research of John Snow, in the 1800s outlined the source of Cholera being water borne pathogens and outlined the necessity of cleanliness and hygiene (World Health Organisation, 2009).

SCHPNs use Public Health England as an informative and reliable source which assists public health practices to ensure improvements in health and wellbeing and to reduce health inequalities. Global threats to public health can include issues such as smoking because it is a leading cause of cancer and other illnesses which lead to death. It has also been linked to a higher prevalence in more deprived areas (Cancer Research UK, 2018, World Health Organisation, 2018).

Public Health England (PHE) published the Public Health Strategy Plan 2020 in 2016 with the objective to tackle certain areas of public health which require to be prioritised. These include obesity amongst children. Governments “Call to Action”, which was implemented in 2011, also includes national ambitions to focus professional attention on addressing the problem of excess weight in children (Department of Health and Social Care, 2011). Obesity is one of the UK’s biggest issues, having nearly tripled since 1975 and 41 million children under the age of 5 being recognised as obese or overweight in 2016 (World Health Organisation, 2018). It is clear that childhood obesity can be seen as an increasing concern. It has been recognised that the highest rates of childhood obesity are from children growing up in deprived areas and these rates are not improving (PHE, 2017).

SCPHN’s are at the forefront of public healthcare and are frequently confronted with high-risk service users and the need for prevention of childhood obesity. Currently in practice the advice given includes; promoting the healthy start scheme, promoting breastfeeding, delaying weaning until 6 months, encouraging children to eat healthy, varied and balanced diets whilst looking at portion size (Department of Health, 2009). Referrals can be made to weight management services as evidence suggests these child and parent interventions result in significant decreases in BMI and can have some beneficial effects on psychosocial outcomes (NICE, 20013). An association has been made between the time spent outside by children and their level of physical activity, therefore, safe and active outdoor play should be recommended for pre-school children (Norfolk Insight, 2014, Gillam et al, 2012).

Maintaining a healthy weight throughout childhood is important because experiences and habits are formed while the young children progress into adult life and are linked to significant health issues, which obese children are more likely to endure (Birch, Savage et al, 2007). These include: Cardiovascular disease, Diabetes, non-alcoholic fatty liver disease and psychological distress (The National Child and Maternal Health Network, 2018).

Health Needs Assessment is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation which will improve health and reduce inequalities in health service provisioning (Cavanagh, Chadwick, 2005). The benefits of Health Needs Assessments include; improved team and partnership working, professional development of skills, a strengthened community involvement in decision making, improved communication with other agencies and better use of resources (Cavanagh, Chadwick, 2005, Scriven, Hodgins, 2012). Health needs and particularly needs in general can be defined as subjective; one person’s need is not the same as another and there are many different views on what constitutes a real need (Wright, Williams et al, 1998). Generally, needs can be thought of as essentials in life such as food, water, warmth and safety. Most of these are socially recognised and agreed upon but with variable opinions about where needs could be concluded (Scriven, 2017, Naidoo, Wills, 2016). The taxonomy of need describes 4 different types of need which include normative, felt, expressed and comparative (Bradshaw, 1972). Bradshaw felt all four types of need combined concluded real need. Bradshaw challenged the view that this was a useful concept in policy making because of the complexity and therefore felt inequalities should be the main concern (Thompson, 2014).Social justice and equity are concepts that feature greatly in public health. The difficulty is that many have different views of what constitutes social justice (Naidoo, Wills, 2016, The Marmot Review, 2010). Examples include utilitarianism which denotes that people strive for the greatest good for the greatest number. However, it opposes the view of libertarians who feel individual’s rights which must not be violated (Naidoo, Wills, 2016). Equity on the other hand, can be split into horizontal equity and vertical equity. Horizontal equity treats everybody the same regardless of differences and vertical equity will aim to treat people differently in order to achieve equal health status (Tao et al, 2014).Approaches to a Health Needs Assessment are based upon the needs, demand and supply basis. I have used this triad of need for my Health Needs Assessment (Blair et al, 2010, PHE, 2016).

There is great need and potential for benefit in targeting young children’s obesity, the demand can be seen from the recognition of effect on services and on the health of the public. The rationale of such a process could be comprehended as approaching the individuals who could be at their formative years of both social and psychological development. This process is particularly effective in distinguishing the needs of both individuals and of communities from each other. This could effectively assist the health service providers to assess the criteria of planning for effective Public Health services. For this purpose, the changing of the existing health mentality is the central point for any Public Health improvement approach.

The Norfolk Health and Wellbeing Board have recognised obesity as one of their three priorities for the Norfolk Health and Wellbeing Strategy 2011-2015 (Norfolk Insight, 2014) and the current Strategy for 2018-2022 emphasises services to focus on ‘supporting people to be healthy’ (Norfolk County Council, 2018). Public Health advocates such as SCPHN’s are required to engage in interventions for these issues and are encouraged to innovate services (Gillam et al, 2012). When implementing plans for public health improvement, challenges and influences can become obstructive. These could include the media, medical influences and social influences and these are needed to be considered throughout the planning stages (Sanders et al, 2018). Challenges to Health Needs Assessments include creating a dependency culture and that it implies that communities are in need of fixing these challenges (Cavanagh, Chadwick, 2005, Scriven, Hodgins, 2012). Health Needs Assessments gather information in order to build a current picture of services and reach a baseline of which to work from. This information is then used to decipher what needs to be changed in order to improve health services. This is important in order to inform commissioning and allocate resources effectively, however, it often only reflects the needs of parts of the local population (Baggott, 2015, Gillam et al, 2012).

Asset based approaches to Health Needs Assessments consider the strengths of the population which may include skills, connections or economic assets which will help counteract the challenges (Naidoo, Wills, 2016). Salutogenesis incorporates the discovery and use of assets such as resistance resources like money or coherence and positivity (Henry, 2013). This concept assists with the underpinning principles of improvement, integration and involvement.

The population focus has been identified as a result of their recognised needs and prioritised because it has raised significant health concerns. The population of children in Norwich, Norfolk, which has seen 22.7% child excess weight in 4-5 year olds. This is an extremely high number and when compared to other areas in the county, shows to be the second highest figure. The trend from 2006-2017 indicates Norfolk’s child excess weight to be getting worse and has recently stayed the same (Public Health England, 2017). The health needs of this population affected by obesity has been recognised nationally as well as locally due to its prevalence and continues to suggest the issue is growing and that it’s not being successfully addressed currently. The population in question have a diverse range of age, ethnicity, class and culture (Norfolk Insight, 2011) which makes it more difficult to reach all groups e.g. some travellers may not send their children to nursery or school and may go undetected. The aim of this Health Needs Assessment is to develop a way SCPHN’s can target and implement improvements for healthy weight and obesity, whilst improving health inequalities. The boundaries may include access to some groups of the population, people feeling this is a negative or ‘shaming’ exercise and having the resources and staff in order to carry out the intervention. Senior management also need to work across professional boundaries, access data and the target population, maintain team impetus and translate the findings into effective action (Cavanagh, Chadwick, 2005). Not all data may be accessible and some data may not even exist, however using the data I am able to gather for my chosen population, I will also look at strategies already in place to improve the obesity rates within the area. Looking at this information it tells me the severity of the situation and the perceptions of the population, service providers and commissioners (Gillam et al, 2012). A windshield survey, performed by driving and walking through the area of Norwich, Norfolk, has been completed and reveals deprivation and obesity in many areas. More than one method of assessment is used in gathering data, this can be described as “the most preliminary and fundamental assessment of the community” and assists in justifying the priority of need (Stamler & Yiu, 2012, p. 218, Mitcheson, 2008).

The targeted location of Norwich, Norfolk has unemployment rates above the national average (World population review, 2019) and has shown increasing crime rates (Norfolk Constabulary, 2018), which when combined with the obesity and deprivation statistics, indicate an area in need of intervention. The aims and objectives include raising awareness of the issues with childhood obesity and helping to encourage and educate the population. When considering what intervention to implement, it is important that it addresses the need in question most effectively (Naidoo, Wills, 2016). Addressing pre-school children and parents directly would be an effective way of making an impact and motivating people (NICE, 2014).

The implementation and evaluation of the intervention may take longer to achieve and are complicated steps in the process. Implementing the intervention will include training SCPHN’s to run the healthy eating workshops and provide resources such as leaflets and information for the families to revisit when convenient. The workshops will need to be scheduled and planned with local community venues such as nursery’s and children centres with motivation and surveillance being filtered down by managers (Cavanagh, Chadwick, 2005). In order to evaluate the results, workshops will be assessed for success, with data gathered from the NCMP a year after starting school. Evaluation questionnaires will be given out at the end of workshops to clarify how parents felt the session was run and whether these were successful in motivating them to adopt healthier lifestyles. Apart from this, the utilisation of interoperability of data could be utilised as well, where, the gathered data could be analysed and trends in the lifestyle changes could be outlined, so as to compare such outcomes with the data of general health situation, involving such pre-school children, which could be also derived from NCMP. This could provide a holistic perception regarding the changes which could take place after the workshops could be concluded. This way, process evaluation and outcome evaluation are more likely to be achieved through such robust approaches (Blair, 2010).

Obesity costs society millions in health and social care, making it a local and national issue (Norfolk Insight, 2014). Though some poverty-stricken countries face starvation, obesity wreaks havoc on western culture (World Health Organisation, 2018) and there are many reasons for this. Unhealthy foods are often readily available and cheap, advertising can make you believe the food is good for you when in fact it is high in sugar, fats and salts or preservatives(The Food Foundation, 2018, The Guardian, 2018). When a family bring children up eating certain foods it enables them to adapt to this lifestyle and that means they find in increasingly difficult to eat in any other way and would struggle to know how to make healthy meals with fresh foods, therefore we consider this a risk factor(Thirlaway, Upton, 2009). In order to improve this, we would need to help people make better choices with the placement of healthy options, details of local weight management programmes and family involvement (National Institute for Health and Care Excellence, 2015). If we were to use an epidemiological triad for this, the agent would be fats, sugars and carbohydrates consumed in food and volume of consumption, the host would be humans and the environment would be marketing, cost, taste and accessibility (Egger et al, 2003).

This emphasises the importance of targeting weight issues at a young age and assisting families in making healthy choices, children cannot choose what to eat at preschool age it is the decision of their caregivers (Blair et al, 2010). The government currently utilise the Healthy Weight Pathway which promotes ‘change4life’, a phone App with healthy eating advice (Change4Life, 2018).This was designed to target and help families, but has not managed to change the course of direction for obesity in Norfolk so far. It could be outlined that some of such interventions could generate perceptual resistance from the parents in cases where the parents of obese children could be abruptly notified that NCMP had categorised such children to be overweight. This could be defined to be initial obstacles which could arise out of the dearth of proper communication between the parents and the NCMP (BBC News, 2015). This also brings forth the necessity to acknowledge the effect of accessibility of information regarding the incidence and effects of obesity as well as the impact it has on the general public health and specifically, on the health of pre-school children. The availability of such information could effectively resolve such challenges of perceptual resistance. Information concerning the processes of incidence of obesity, the effects and the impact of the same on human health could now be accessed through online media including the social networking sites. Such information could be effective to gradually raise the awareness level of the general populace regarding obesity as a disease the methods to avoid this. Some effective information could be the positive effects of having balanced diet and proper exercising for the pre-school children. Health campaigns are mostly focused on such awareness enhancement (Thompson, 2014, Scriven, 2017).

Adult and juvenile obesity are interlinked and these lead to, primarily, cardiovascular diseases and diabetes in the patients (World Health Organisation, 2017). In Norwich, a quarter of children are overweight when they start primary school in Norwich (25%) and nearly a third are overweight by the time they leave primary school (31%) (Norfolk County Council, 2015). The trend in Norfolk has seen an increase in the proportion of children who are overweight at reception age and this surpasses the regional average of such obese children (Norfolk Insight, 2014).Interestingly obesity prevalence was higher for boys than girls, however whether this takes into consideration the ratio of girls to boys is unclear (NHS Digital, 2018).

Norfolk is subject to significant health inequalities with children living in the more deprived areas more likely to be admitted to hospital and more likely to suffer from ill health such as obesity (Norfolk County Council, 2015). Within Norwich, January 2018 data showed that North Norwich had a rate of 26.3% in poverty and Norwich South had a rate of 30.5% in poverty with these levels likely to rise in the future (End Child Poverty, 2018).

Health inequalities need to be addressed by SCPHNs in practice as determinants of health are evident throughout society as factors such as unemployment, poverty and housing is linked to health inequalities. Documents and policies which are important within SCPHN practice highlight the importance of reducing inequalities in early development to build resilience and wellbeing of children across the social gradient (Public Health England, 2016). The Marmot Report Fair Society, Healthy Lives (Institute of Health Equity, 2010) has been one of the latest documents to show that social inequalities still exist and that addressing these issues will provide us with economic and health benefits. As public health practitioners SCPHN’s are working together with families to identify and select appropriate measures to encourage health equality as a matter of justice (Institute of Health Equity, 2010). Obesity has already been linked to poverty, the prevalence is much higher in areas of deprivation which means there is likely to be a link between poverty and health in general which indicates that health inequalities play a part in the prevalence of this issue. In Norfolk, there are a third more overweight children in the most deprived areas (Norfolk Insight, 2014).

Health promotion can be defined as ‘the process of enabling people to increase control over, and to improve their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions’ (World Health Organisation, 2018). Health promotion is a critical component for SCPHN practice as it drives the development of health education and healthy policies. The three levels of health promotion include primary, secondary and tertiary. At primary level there is the reduction of disease and prevention, at secondary is reducing the prevalence of disease and tertiary includes the reduction of disability caused by disease(Scriven, 2017). Different approaches are taken to improve health promotion and empowerment and educational approaches are ones seen in practice frequently (Laverack, 2016). Educating families about disease prevention and safety, being able to promote healthy living and assist with this using their strengths is both educational and empowering. SCPHN’s need a multi-disciplinary approach to work with clients to achieve the full potential as we may not fully understand their lived experience and they may not have the knowledge of risk we can offer. There are different types of theories and models on health promotion which can be used to provide an evidence base or guidance on achieving health promotion. For example, the Trans-Theoretical model by Prochaska and Diclemente (1982) uses steps for behaviour change in order to implement health promotion and this is a model used often by healthy lifestyle coaches. The application of this model could outline the most suitable method through which pre-school children, along with their parents, could be provided professional guidance by the lifestyle coaches to progress towards a greater healthy lifestyle. The stages consist of pre- contemplation, contemplation, preparation, action, maintenance and relapse or termination (Thompson, 2014, Scriven, 2017). Strengths in this model consist of different stages in the change, being applicable to real life situations, applying preparation as part of the model which is key to success and being diverse enough to be used for many different health issues. Criticisms of this model includes the lack of preventative measures used, the fact it relies on parents engaging and the individualistic focus of the steps which may not be suitable for all. This model and the Health Belief Model could both be used to assist with the health promotion and health behaviour change for obesity. The health belief model centres around the concept that people are motivated when they felt they were susceptible to the condition in question/it was relevant to them and how much it may benefit them to take part in the action suggested (Mitcheson, 2008).

The role of the SCPHN throughout this process is to identify concerns early for the family and those who may be at risk or experience obesity and to prevent the risks by giving guidance. They are required to work with families to educate and assist in developing better nutritional meals for children and to monitor and identify what may be causing such a rise in childhood obesity as well as preventing further risks(Naidoo, Wills, 2016, Sheldrake, Robotham, 2000). Some children are at higher risk and therefore require specific support which could be effective to address particular risk factors, these risk factors include; parental obesity, history of heart disease or diabetes, poverty, race, birth weight, bottle feeding and early weaning (Department of Health and Social Care, 2009).

Challenges for combating childhood obesity stretches beyond the expense of healthy food, family traits or a lack of knowledge around food itself, but also entails psychological elements. This could be identified to be the crux of the focus of this study since the necessary changes in the lifestyles of pre-school children could be instituted through psychological stimulus in the form of the positive perceptions of the beneficial elements of such changes. Otherwise, children are still likely to experience stress, bullying, segregation, self -confidence issues and practical difficulties as a result of obesity (Thirlaway, Upton, 2009).

It has been recognised that whilst many problems currently impacting public health such as smoking and poor diet, could be reduced significantly by making changes in individual behaviour (PHE, 2018). When starting to plan a behaviour change, it is necessary to understand the audience, behaviour, levers, design the intervention and evaluate (Mitcheson, 2008). In order to implement this on a population it is important to think about policies, resources and the triggers which may be influencing behaviour. Social media has a big impact on society and evidence of targeted advertising is regularly seen on TV, heard on the radio or seen on public billboards amongst other sources (Thompson, 2014). In order for people to understand obesity concerns are relevant to them and how detrimental this can be to health and the health of their children social media could provide a great platform to increase awareness. Community events and normalizing the topic can help to encourage people to feel comfortable to talk about and tackle this health concern. Smartphones provide easy and quick access to the internet and apps which can assist in targeting our audience and providing a flexible way of them accessing the information and help they require, which may help to make them feel more in control (Naidoo, Wills, 2016).

Effective partnership and collaborative working are key to providing public health services that succeed in providing positive changes, Joint strategic needs assessments and Health and wellbeing strategies good examples of this as they are able to share evidence, gather their resources, dissolve the barriers, access networks and combine funding (Scriven, Hodgins, 2012, Mitcheson, 2008). Health and wellbeing boards are usually chaired by local authority elected members and include representatives from local authorities (The Kings Fund, 2013). These boards serve to produce Joint Strategic Needs Assessments (JSNAs) and help to assess the needs of the local population. These strategies as well as joint commissioning, shared budgets and integration help to promote partnership, however a criticism could be the limited formal powers they hold (The Kings Fund, 2016, Thompson, 2014). JSNA’s are required to assess and bring to light health and social care needs of the local population and ascertain what needs to be done to make improvements. Communities usually consist of people that live in the same neighbourhood or are part of a group, however they can be complex and ever-changing. Healthy communities are active and friendly, safe and readily accessible to all (Cowley, 2008). Communities in deprivation suffer with poorer health, quality of life and cost the country millions in lost productivity, welfare and taxes. The cost of inequalities in obesity alone is set to rise from 2 billion to nearly 5 billion a year by 2025 (Marmot, 2010). The Five Year Forward View (2014) outlines the NHS planning and guidance measures for improving health and patient care. This document presents a new approach (NHS England, 2014). In order to strengthen the ability of the community develop cohesion and partnerships are to be developed (Baggott, 2013), we can do this by expanding our support and creating an accessible infrastructure. Social relationships and the relationships SCPHN’s have with clients will have a great impact on community engagement and provide a greater chance of reducing inequalities in health (Department of Health and Social Care, 2011, Naidoo, 2010).

SCPHN’s already communicate with clients and communities about health promotion and work to raise awareness of how to improve health and social wellbeing. In the capacity of my identified Health Needs Assessment, it will help to improve outcomes for obesity in children if we start to develop the confidence of families and communities by using the services and information provided. This will help to develop community resources, improve health, maximise family resources and builds on what is already working well(Sheldrake, Robotham, 2000).

Health promotion forms a big part of health and wellbeing programmes of the Public Health England, with one of the main focuses being nutrition and physical fitness (Naidoo, Wills, 2010). In order to prevent these health concerns 3 areas are required which include prevention of the disease, early detection and prevention of disability which are called; primary, secondary and tertiary (Worls Health Organisation Europe, 2019). SCPHNs work as part of a health protection team that help to provide disease surveillance and use the information given by Public Health England to provide an evidence base and guidance through their practice. This involves screening programmes and obesity falls under a screening programme, which for children is encompassed in the National Child Measurement Programme (NCMP) and for adults is measured more by their GP on an as and when basis(Gillam et al, 2012, NHS Digital, 2018). The National Child Measurement Plan involves taking the height and weight of pre-school children in reception and year 6. This data is then analysed for trends and to identify areas of higher need (Norfolk Insight, 2014). Parents will then receive a letter detailing the children’s measurements and to which category this translates into. Overweight children are offered information about healthy weight services (Department of Health and Social Care, 2009). This data also enables us to estimate how many children are affected by excess weight in Norwich to be 3,300 aged between 5-15 years (Norfolk County Council, 2015). Although this data is useful in identifying how many children are overweight at this age, it has recognised that a high percentage of children are already overweight and perhaps more should be done to recognise this at an earlier stage or to prevent, which could be a criticism of this screening method.

The intervention had been the workshops promotion the awareness of healthy eating and this had been taken by trained Health Visitors in community setting’s such as nursery’s and children’s centre workshops are likely to succeed in targeting childhood obesity. The rationale of such conceived effectiveness could be outlined as the focus of such workshops on improving outcomes for children and families, for example in weaning workshops. These centres allow for multi-disciplinary teams to offer innovative services and encourage community engagement and user participation(Department of Health, 2007). It has also been recognised that programmes aimed at the parents have a significant impact on childhood obesity (Department of Health and Social Care, 2009, p. 43). Weaning workshops are optional, but for the healthy eating workshops I would invite all parents within pre-school ages in the area to attend a session and enclose details on what will be covered in the session and why. This way, no one will feel ‘targeted’ or ‘blamed’ and it will be a universal offer that will assist in tackling inequality at the same time as once there we can spend time with those who need the help the most without them feeling singled out(Naidoo, Wills, 2010). I had considered earlier screening for child measurement (before starting school) and one to one intervention as this is a time when children are already likely to have formed bad eating habits, however the cost of one-to-one Health Visitor work for this large- scale issue would not be appropriate.

With this intervention, I hope to achieve community cohesion and motivation. Once at the workshops parents can communicate and provide positive reinforcement to each other. It may help to target social isolation and will help Health Visitors to see which parents may be struggling the most and why(Naidoo, Wills, 2016, Sheldrake, Robotham, 2000). In turn, we should start to see changes in the way parents are feeding their pre-school children and eventually a reduction in obese and overweight children starting school, as this method demonstrates an upstream and downstream approach (Naidoo, Wills, 2016). The sessions are intended to be relaxed, informative, interactive and with time given for questions/one-to-one discussion at the end, therefore making it a flexible session that avoids being too daunting or oppressive and negative. As public health practitioners and specialist health promotion pioneers I feel that Health visitors are in a prime position to run these sessions and gain maximum return in results (Cowley, 2008). The cost of obesity is so big that in comparison the cost of running these sessions is a valuable source for the community and will save money in the long run. The strengths of my intervention include; being relatively cost effective to run, including all age appropriate children and parents, a positive way to introduce weight management in young children through an engaging and motivating way and being a flexible and informative way to make parents understand the importance of these issues. Weaknesses may be that some people may not attend the sessions, the workshop venues would have to have the availability and agree to the sessions being held providing they are kept open (The Kings Funs, 2015).

In order to evaluate the intervention for this Health Needs Assessment, information will be gathered in a systematic way for comparison(Scriven, Hodgins, 2012). Throughout the evaluation, process, impact and outcomes will be looked at (Blair, 2010). This will mean the method used and outcomes achieved will be assessed, which I have used a logic model to assist with (Community Toolbox, 2018).Questionnaires will be left for attendees to complete once the session is finished to anonymously feedback on how they felt the session went and how this may have impacted on their choices for the future as this is a recognised evaluation approach (Mitcheson, 2008). The NCMP will then start to either show a steady improvement as the sessions are run and it filters through the age group or there will be no difference and we will know that perhaps this intervention has not succeeded in making an impact on childhood obesity, thus giving us the outcome evaluation. Regardless, the questionnaires should help to improve the sessions as parents will have an opportunity to fill in suggestions for improvements and comment on parts they liked/didn’t like. Asking the parents to fill the form out before they leave will ensure that we actually get feedback. This will measure short term/immediate effects and can also be used to see that the sessions are being run in a similar manner by all practitioners e.g. if all the feedback states the handouts were useful and they found the sugar content interesting, it will reassure us everyone is getting the same information. Though to ensure this is the case, training and a session proforma will be provided to practitioners.

In conclusion, through thorough data research and analysis I identified a Health Need of childhood obesity in my chosen population of Norwich, Norfolk and have developed an intervention that best suits the needs of the families involved. Obesity is preventable and SCPHN’s have a key role in identifying risk factors and working towards health promotion that tackles health inequalities and improves public health. This intervention will give all families the opportunity to have the knowledge and embrace positive changes for healthier lifestyles.

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