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307CPD Health Promotion Question: Students are required to design, write and justify a detailed project proposal for a health promotion project on a topic of their choice. The student will need to include the following in their proposal:  • Explain & justify the need for a specific health promotion initiative using evidence • Devise an implementation plan for health promotion in a community setting • Apply and critically evaluate the health promotion theory used in the delivery of the proposed promotion project justifying their choices  • Demonstrate that the project proposal encompasses wider ethical, philosophical and cultural issues in the implementation. Answer: Rationale The focus of the paper is on childhood obesity in Bexley borough of London. According to the new NHS figures every one in five children are obese in this region. There is a 9.5% increase in childhood obesity between 2010-2015 (Conner 2017). According to Griffiths (2017) six years old children at risk of obesity in Bexley is higher than average of 20%. When compared to any other Borough in London, Bexley has been found with eighth biggest increase in population of obese children. The paper puts forward health promotion proposal for tackling the childhood obesity in children aged 5-11 years living in this area. Physical activity, BMI, sedentary lifestyle and nutritional factors determine obesity in children (Kipping et al. 2014). The reason for increasing obesity in primary school children in Bexley is low level of physical activity. As per Conner (2017), only 41.9% of primary school children in this area are engaged in physical activity and only for three hours per week. These children are more engaged in watching TV and indoor games and poorly engaged in physical activity. Parental influence may be responsible for high calorie consumption in children, junk food and weight gain. Preschoolers are known to consume high amount of dairy products in developed countries (Dror 2014). Working parents do not monitor the child’s eating behaviour, or diet pattern (Wilkie et al., 2016). Children travel to school more on motor cars and it gives no opportunity to walk. This lifestyle prevents child from even mild physical exhaustion (Easton and Ferrari 2015). Hence, it justifies the selection of the target population for the health promotion plan.  These adverse health effects of childhood obesity are manifested in adulthood and leads to poor quality of life as obesity in children tend to persist into adulthood. It is estimated that 50% of the children who were obese in pre or primary school remain obese in adulthood (Sahoo et al. 2015). Therefore, it is necessary to intervene this condition at early age to prevent its comorbidities in adulthood. In order to establish healthy lifestyle, intervening in early life is essential. It will aid in modifying behaviour in children. For this research, the intervention is based on community level, which includes promoting physical activity and diet in children of 5-11 years in two schools in Bexley. The reason for targeting the schoolteachers and parents for this health promotion plan is significant amount of time spent by them with the children aged 5-11 years. Consequently, they will be influential in enhancing positive behavioural change in children (Hemsley-Brown and Oplatka 2016). Reducing the option of unhealthy food in school canteen and replacing with fruits and vegetables will force the children to consume available food items. (Reichmann 2009). Daily consumption may lead to increase in motility of the substances through digestive tract (Dror 2014). It will aid in faster elimination of fats from the body and reduce obesity The practice of physical activity in childhood will reduce weight. Moreover, these healthy behaviour will persist through the adulthood therefore, preventing sedentary activities in later life (Ho et al. 2013). The intervention also includes spread of awareness among parents in the community (Bexely) through campaigns. Since young children are not able to make health related to choices, educating parents is vital to improve health literacy and reduce the risk of obesity in children (Sahoo et al. 2015). Parents will have knowledge on activities that will ensure good health of their children. Consequently, they will participate actively in reducing time of their children spent being sedentary. Knowing the health benefits will help parents to create environment in home that is conducive for the children to progress towards healthy lifestyle. Campaigns are best way to create mass awareness and promote health related behaviours (Barry et al. 2014). Project Outline The health promotion plan firstly targets a primary school in Bexley for promoting Fruits and vegetable consumption and physical activity particularly Running. Promoting this behaviour will reduce the prevailing issue of physical inactivity and diet by May, 2018 For feasibility, only one school in Bexley will be targeted initially with a total student strength of 500. Initially, a sample initiative will be conducted for a period of 90 days (for predetermined anlysis) and later awareness initiative will be conducted with the consent of the associated teachers and family. Fruits and vegetable consumption can be increased by prohibiting the canteens to sell junk food. Fruits and vegetables are rich in fibre.  Other healthy items such as fruit juices and items having low calorie content will be introduced in school canteen. For further implementing the awareness programs and the running strategy, partnership will be established with the education departments and the sports centre in Bexely Borough of London. Further, both quantitative and qualitative analysis will be performed to evaluate the outcomes. Prior to implementing the plan, the weight and BMI of each children will be recorded which will then be compared to the BMI after a period of one year. The second step of the health promotion plan is to launch a campaign for parents of obese children. The childhood obesity campaign in Bexley will be held for two weeks. The childhood obesity campaign will help parents to involve in lifestyle and weight management program for their children. It will inform parents about the dietary requirements of children aged 5-11 years, risk factors of obesity and the protective factors for their children.  It will also inform them about the cost effective healthy choices that can be implemented to prevent obesity or reduce weight. Different psychological theories are developed that act as a framework for health promotion. This plan is underpinned by theory of observational learning, which refers to learning by observing behaviour of other people (Matias, et al., 2014). The more the children observe the display of healthy food in their school environment the more likely they are to consume. In addition, observing peers participating in physical activity and games will motivate others to do the same. It is an important tool for modelling social behaviour. The behaviour choice model also guides the plan. According to the model when limited choices are given an individual tend to pick the best one and it is applied in this plan for decreasing option of fast food (Hemsley-Brown and Oplatka 2016). The campaign is guided by the theory of health persuasion where persuasion will occur when parents will understand factor promoting childhood obesity who will then actively engage in the preventive intervention at home such as monitoring diet (Rushnell and Beattie 2016). Aim The aim is to promote physical activity by incorporating running in daily routine. The aim is to curtail junk food habits for weight management in the obese children by replacing with fruits availability in school canteen. Increase the awareness of the parents regarding the risk factors and adverse health consequences of childhood obesity by awareness campaign Objectives And Outcomes  Objectives Outcomes Ensure increase in physical activity in target school of Bexely borough of London in children 5-11 years of age  by running activity incorporated in daily routine in June 2017 Greater involvement of children in physical exercises and other  running competitions initiated in target school  by the May, 2018 Reducing the amount of fast food consumed and increase in consumption of vegetables and fruits in children 5-11 years  by prohibiting the sell of fast food items in school   Reduce intake of calorie and fat rich food in schoolchildren.  Increasing consumption of fruits and vegetables. Reduction in body mass index and physical fitness and the improvement will be evident from comparison of weight and BMI scores before and after the intervention. To partnership with the sports centre in the community and other education departments to organize racing competitions in schools and develop school based running strategy to promote physical activity in children via workshops, seminars involving children,  parents and teaches   Effective partnership will be achieved between the sporting clubs and other agencies. Increase in children health literacy of the parents through two weeks  campaigns Acquaintance of parents with medical terms, consequences of obesity, knowledge on child nutrition and health promoting behavior for children through information provided in campaign. The change in perceptions of parents will be evident from the survey conducted later using open-ended questionnaire after 90 days. Initially a 90 day sample initiative will be taken to project the importance of running, and its implementation in daily routine in school. The initiative may include  one hour running per day, followed by twice  a week and  after school with consent from parents and teachers   It may increase the awareness in community about running and its health outcomes  that may provoke other schools to implement similar program. (Source: created by author) Process Evaluation: Ensure facilitation of First Aid in case of any injury or accidents Weekly analysis of the school based interventions  by collecting data (Kipping et al. 2014) Identify the issues related to running among children and implement optimal methodology Partnership with sports club in Bexely to organise racing competitions Collect feedback from children and school authorities on their perceptions and experiences to assess the level of awareness Awareness campaigns will be regulated using pamphlets, flyers, brochures, and other activities Recruitment of trained physical educator for running activity, interns and volunteers for awareness  campaign for starting project at ground level Training of the volunteers and the interns to ensure safe physical activities Assistance from general practioners to measure BMI before and after intervention Ensure canteen staff is well instructed to sell only fruits and vegetable and no other fast food items and items with high calorie content   Formulation of questionnaire  for collecting data on parents and teachers  perception about the school based intervention and awareness campaign Regulate meetings with teachers and different member associated for analysis of the intervention (Robinson et al. 2014) Outcome Evaluation:  Increase in fruit consumption among children that will be evident from the data collected from teachers and parents using questionnaire. Effective analysis of the feedback An increased level of awareness is expected in parents and school teachers in the target area The outcomes will be evaluated using BMI data before and after intervention and comparing the same after completing the one year project Obtaining more funds to conduct the intervention on large scale Expected results are decrease in weight of overweight children and overall physical fitness in both overweight and non-overweight children. The equilibrium in BMI will be measured as per the guidelines  recommended by the WHO (Flint et al. 2014) Sport centres are expected to give more support and department of transportation to allocate sufficient fund for the campaign process  and racing competitions for large sample size (Aldred and Jungnickel 2014) Parents will actively engage in modifying the lifestyle of their obese children Possible Project Limitations There may be some limitations hampering the intervention method particularly the promotion of physical activity among the children aging between 5-11 years. Lack of effective coordination and approach by teachers, parents and children may prevent effectiveness awareness. It may lead to failure of implementing the instructions related to fruits consumption. There may be social and cultural obligations preventing the fruits and vegetables consumption in school canteens such as fat acceptance in some cultures. It may prevent the parents from promoting children for diet modification (Ritchie et al. 2013). Parental feeding behaviours differ in different ethnic groups (Gu et al., 2017). Since, initially a 90 day sample initiative will be taken, it will help in predetermined analysis such as top down to down approach or authorative approach as of Beattie framework (Rushnell and Beattie 2016). The large-scale implementation of the program may be inhibited by lack of funding and shall restrict the project to 500 students with age 5-11 years in Bexley borough of London. Additional Information  This initiative empowers both parents and children along with associated teachers. The intervention strategy has the potential to promote optimal health and hygiene practice using evidence-based options with limitations to implementation of program. The values, beliefs and ethics of the targeted individuals shall be preserved (Kraemer, Spears and Arcury 2015. The paper by Dingwall et al. (2017) highlights the importance of preserving the ethics on basis of beneficence, justice, and non-maleficence. Throughout the conduction of the health promoting plan ethical factors shall be considered. References Aldred, R. and Jungnickel, K., 2014. Why culture matters for transport policy: the case of cycling in the UK. Journal of Transport Geography, 34, pp.78-87. Barry, C.L., Gollust, S.E., McGinty, E.E. and Niederdeppe, J., 2014. Effects of messages from a media campaign to increase public awareness of childhood obesity. Obesity, 22(2), pp.466-473. Conner, R. 2017. More than one in five children in Bexley obese. [online] News Shopper. Available at: [Accessed 24 Apr. 2017]. Dingwall, R., Iphofen, R., Lewis, J., Oates, J. and Emmerich, N., 2017. Towards common principles for social science research ethics: A discussion document for the Academy of Social Sciences. In Finding common ground: Consensus in research ethics across the social sciences (pp. 111-123). Emerald Publishing Limited. Dror, D.K., 2014. Dairy consumption and pre?school, school?age and adolescent obesity in developed countries: a systematic review and meta?analysis. Obesity reviews, 15(6), pp.516-527. Easton, S. and Ferrari, E., 2015. Children’s travel to school—the interaction of individual, neighbourhood and school factors. Transport Policy, 44, pp.9-18. Flint, E., Cummins, S. and Sacker, A., 2014. Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom. BMJ, 349, p.g4887. Griffiths, J. 2017. Shocking new figures show child obesity in Bexley has risen by 9 since 2010. [online] News Shopper. Available at: [Accessed 24 Apr. 2017]. Gu, C., Warkentin, S., Mais, L.A. and Carnell, S., 2017. Ethnic differences in parental feeding behaviors in UK parents of preschoolers. Appetite, 113, pp.398-404. Harrison, N., 2014. Obesity and public health campaigning. The Lancet Diabetes & Endocrinology, 2(2), p.109. Hemsley-Brown, J. and Oplatka, I., 2016. Personal Influences on Consumer Behaviour. In Higher Education Consumer Choice (pp. 44-64). Palgrave Macmillan UK. Ho, M., Garnett, S.P., Baur, L.A., Burrows, T., Stewart, L., Neve, M. and Collins, C., 2013. Impact of dietary and exercise interventions on weight change and metabolic outcomes in obese children and adolescents: a systematic review and meta-analysis of randomized trials. JAMA pediatrics, 167(8), pp.759-768. Kipping, R.R., Howe, L.D., Jago, R., Campbell, R., Wells, S., Chittleborough, C.R., Mytton, J., Noble, S.M., Peters, T.J. and Lawlor, D.A., 2014. Effect of intervention aimed at increasing physical activity, reducing sedentary behaviour, and increasing fruit and vegetable consumption in children: active for Life Year 5 (AFLY5) school based cluster randomised controlled trial. Bmj, 348, p.g3256. Kraemer Diaz, A.E., Spears Johnson, C.R. and Arcury, T.A., 2015. Perceptions that influence the maintenance of scientific integrity in community-based participatory research. Health Education & Behavior, 42(3), pp.393-401. Matias, C., O’Connor, T.G., Futh, A. and Scott, S., 2014. Observational attachment theory-based parenting measures predict children’s attachment narratives independently from social learning theory-based measures. Attachment & human development, 16(1), pp.77-92. Reichmann, V., 2009. Does Fruit and Vegetable Intake Decrease Risk for Obesity in Children and Adolescents?. Undergraduate Honors Theses, p.8. Robinson, M.N., Tansil, K.A., Elder, R.W., Soler, R.E., Labre, M.P., Mercer, S.L., Eroglu, D., Baur, C., Lyon-Daniel, K., Fridinger, F. and Sokler, L.A., 2014. Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review. American journal of preventive medicine, 47(3), pp.360-371. Rushnell, C. and Beattie, M., 2016. A project mAnAgement frAmeWork of heAlthcAre InformAtIcS InItIAtIveS. Healthcare Informatics: Improving Efficiency through Technology, Analytics, and Management, p.79. Sahoo, K., Sahoo, B., Choudhury, A.K., Sofi, N.Y., Kumar, R. and Bhadoria, A.S., 2015. Childhood obesity: causes and consequences. Journal of family medicine and primary care, 4(2), p.187. Shrewsbury, V.A., Baur, L.A., Nguyen, B. and Steinbeck, K.S., 2014. Transition to adult care in adolescent obesity: a systematic review and why it is a neglected topic. International Journal of Obesity, 38(4), pp.475-479. Solmi, F. and Morris, S., 2015. Association between childhood obesity and use of regular medications in the UK: longitudinal cohort study of children aged 5–11 years. BMJ open, 5(6), p.e007373. Wilkie, H.J., Standage, M., Gillison, F.B., Cumming, S.P. and Katzmarzyk, P.T., 2016. Multiple lifestyle behaviours and overweight and obesity among children aged 9–11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ open, 6(2), p.e010677.

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