Part B 5 Case Study 1
Exploring FST Principles in Community DevelopmentāThe Carrot on a Stick Early Health Intervention Program
The Carrot on a Stick community health and lifestyle program was the first of four case studies designed to consider the relevance of the principles of FST detailed in Part A of the book. This chapter explores the value of the principles from a retrospective perspective. The principles found in this intervention demonstrate the durability of the principles and their potential usefulness as a systemic evaluation tool.
Carrot on a Stick was a successful community health intervention that delivered over 36 āHealthy Lifestyleā workshops in Far North Queensland between January 2009 and June 2011. I was employed as a facilitator, teaching cooking and nutrition to the adult participants of the project. Carrot on a Stick appeared to me to be a worthwhile project to explore the value of the emergent FST framework. This case study seeks to gain insight into the application of FST principles and asks if FST principles can be used in isolation or as a set? Can they be used in retrospective analysis, and might this have a bearing on the design of new projects? The purpose of this study was not to evaluate the Carrot on a Stick program, but rather to retrospectively explore the five FST principlesā relevance to the design and implementation of Carrot on a Stick.
Carrot on a Stick has been a creative solution to a well-identified and significant social and community health problem of poor nutrition, low levels of exercise, placing people at risk of developing obesity and Type 2 diabetes. Carrot on a Stick aims to enhance the long term health and well-being of families by increasing peopleās participation in physical activity and promote good health and nutrition (Teece 2008). Carrot on a Stick was auspiced by the Cairns Regional Council (CRC). The funding was obtained through Queensland Government health promotion initiatives; Connecting Healthcare in Communities 2007ā2011, Queensland Health, Eat Well, Be Active: Community partnerships program, Queensland Departments of Local Government, Sport and Recreation, and Community Renewal, Juggling Food, Health and Fun initiative, Queensland Government Department of Housing (Gosling 2008a, 2008b; Teece 2008); with ongoing assistance from Cairns Regional Council.
Carrot on a Stick targeted families at high risk of late onset Type 2 diabetes. A whole of family approach was considered as an effective way to change patterns of poor diet and inactivity (Gosling 2008a). In 2006, the Queensland Government reported that 21 percent of school aged children were overweight or obese and that the figure was rising (Gosling 2008a). On average, Queensland children aged 6ā15 consumed diets in which:
ā¢ 50 percent of their energy intake was derived from carbohydrateānearly half of which was sugar, and
ā¢ 32.5 percent of their energy intake was derived from fat, of which 14.5% was saturated fats (Gosling 2008a, 2008b).
Other indicators suggest that Queensland children have low intakes of vegetables and fruit and daily recommended levels of physical exercise diminished from the age of 6 to 15 where:
ā¢ One in six āyear 1ā1 boys; and one in 15 āyear 1ā girls met daily physical activity recommendations,
ā¢ This fell to one in eight boys; and one in 20 girls acquiring the daily physical activity recommendations in āyear 10ā (Gosling 2008a).
Workshops were run after school hours and during school holidays at community venues and schools. The specific program intentions, objectives and curriculum are provided in Table 5.1. Several assumptions about the target groups were made explicit by the originators of the program project in the project funding application phase. These included that the participants would come from predominantly diverse and Indigenous cultures and low socio-economic groups. The target groups, it was assumed, would not be engaged in regular exercise and may be at risk of being overweight or physically unfit, but that the children of the target groups, would be enthusiastic, willing and regular participants of the weekly workshops, and encourage family commitment to the program. The stated intention by the originators was that participants would learn new skills to enable them to adopt a long-term lifestyle that is physically, socially, emotionally and psychologically healthier (Gosling 2008b).
During every workshop, the parents joined together in the kitchen to cook a meal whilst the children exercised and learned fine motor skills in circus, dancing or acrobatics. Professional facilitators supervised the children, whilst childcare workers minded babies and toddlers. All this, enabled the parents to spend time with other parents. My role as the cooking and nutrition facilitator was to coordinate the cooking of a healthy meal, teaching skills and imparting a nutritional ālessonā in every session. The topics included reading the nutrition labels on processed foods; how Type 2 diabetes develops, is prevented and managed; the fat, sugar and salt content of snack and fast-foods, and so on.
Table 5.1 Carrot on a Stickās Program Intentions, Objectives and Curriculum
The stated objectives of the program were to: ā¢ Promote the āGo for 2 and 5ā message (daily servings of two fruit and five vegetables). ā¢ Learn how to prepare healthy food. ā¢ Create discussion within families about healthy food choices. ā¢ Improve focus and trust. ā¢ Work physically as a team. ā¢ Build strength and flexibility. ā¢ Build self esteem. ā¢ Improve knowledge of good oral health. ā¢ Improve hygiene. ā¢ Build better partnerships with a range of primary health service providers. |
A different nutrition topic was presented each week for discussion. These included: ā¢ Type 2 diabetes. ā¢ Reading nutrition labels. ā¢ Food for strong teeth. ā¢ Shopping on a budget. ā¢ Adapting recipes. ā¢ Take away food. ā¢ Lunches and snacks. |
A preliminary evaluation after six months indicated that the program has so far: ā¢ Addressed social isolation; helping parents to increase confidence, meet people and make friends. ā¢ Improved self-esteem through adults learning life skills and children engaging in physical exercise and performance. ā¢ Increased enjoyment of exercise in a safe, non-competitive environment for some children who arenāt engaged in sport. ā¢ Included all children with different abilities in physical activity. ā¢ Addressed behavioural issues by identifying and encouraging the childās interests within the activities offered and giving positive feedback. ā¢ Improved fine and gross motor skills through learning circus skills. ā¢ Promoted a positive engagement between families and schools. ā¢ Engaged young people and allowed the whole family to participate in physical exercise together. |
Source: (Gosling, 2008a, 2008b).
The purpose of this case study was not to evaluate the Carrot on a Stick program but to retrospectively explore the five FST principlesā relevance to the design and implementation of Carrot on a Stick. A qualitative framework was selected for this study. A non-foundational theoretical position and participatory approaches enabled me to explore the applied boundary, scope and context of the existing community development project from the unique perspective of participant/observation, with the use of survey data and desktop literature. The qualitative methodology approach is consistent with the epistemological background of FST.
Three different sources of information were used within a qualitative research framework. These were a purposefully designed questionnaire (see Table 5.2); analysis of the programās documents, and personal reflection. Each is discussed in turn below. The mix of methods was used to gain a comprehensive perspective of the program and to reduce the possibility of the author/practitioner skewing the outcomes. This is similar in approach to Midgleyās (2000) ācreative design of methodsā where various elements of the research projects are synthesized. The survey was designed to promote contemplation of each FST principle and the literature was scanned for references to, or instances of, applications of the FST principles, (even though the program originators do not refer to the FST principles specifically which were unknown to the creators at the time the program was conceived). The FST principles do not have to be articulated in the development and implementation of projects for them to be present in a program. Finally, my observations and reflections of the program, in relation to each principle, provided critical reflection on the program in terms of each principle, from the position of an employee of the program. A multiple perspective is necessary as āReflective practice requires continuous openness towards all approaches that can shed new light on [situations]ā (Ulrich 2003, p. 339).
The coordinator of Carrot on a Stick agreed to act as a āgatekeeperā to assist in identifying six participants which the author then interviewed in a 10-minute telephone questionnaire. The gatekeeper and I discussed issues that might affect participation in the project. We identified several barriers that may limit peopleās willingness to participate. These included childcare concerns, the use of air-conditioned office venues and eye contact with the interviewer. The use of air-conditioned office venues for surveys was dismissed because the atmosphere of these venues can be disliked by Indigenous people. Similarly, venues on the second or third levels of buildings are not preferred because people dislike being off the ground. Eye contact, especially between child and adult, is considered rude in some Indigenous communities and is avoided as a sign of respect. Written surveys can also be problematic for people with low levels of literacy, and may induce awkwardness or shame. It was agreed that telephone surveys enabled the participants to experience a level of familiarity with the researcher that avoided the discomfort factors identified. The gatekeeper made initial contact with participants, inviting them to participate in the survey. If they accepted, she emailed the personās name and contact phone number. This project received ethical approval from the University of Queensland.
All six interviewees were mothers aged 35ā55. All participants were Indigenous Australian, Polynesian, Philippine or Maori. Two interviewees had more than four children, two were single parents (divorcees), and one was the mother of a severely disabled child. Three participants were known to me, and three were not. The questions were designed to reflect the underlying ethic of each principle and ascertain their prevalence and relevance in Carrot on a Stick.
Table 5.2 Carrot on a Stick Survey Instrument
Carrot on a StickāQuestionnaire |
Personal details: |
Sex |
Age |
How many children? |
Partnered/single? |
Ethnicity |
1. | Thinking about how you found out about Carrot on a Stick. Can you tell me why you signed up to do the program. | P1 |
2. | What were the sexes of the people you worked with? | P1 |
3. | Was the program designed for women or for men? | P1 |
4. | Why do you think that women more than men are participate in the Carrot on a Stick program? | P1 |
5. | Could anyone sign onto the program? | P2 |
6. | What features (if any) of the program made you feel valued as a participant of the program? | P2 |
7. | Thinking about āthe environmentā. Can you define the āenvironmentā for me? Can you think of any time where you were encouraged to think about our impact on the environment during the program? | P2 |
8. | Do you think the program should encourage people to think about the environment more or less and why? | P3 |
9. | In your opinion did the program teach you about health problems affecting our community? | P4 |
10. | Do you agree that Carrot on a Stick should promote and achieve changes to how we eat, exercise and what food we buy? | P5 |
11. | What did you want from the program when you signed up for it? | P5 |
12. | Have any changes you made in your life been lasting? | P5 |
The coordinator of the program also surveyed every adult participant of Carrot on a Stick in a one-on-one interview undertaken at the end of each workshop. A random sample of 30 of these evaluations, from a collection of over 150, was provided to me. The original set of funding application forms, and a four page preliminary evaluation (Teece 2008; Gosling 2008a, 2008b) was also made available. This was a desk-top, note-taking reading of the documents to find instances of explicit or implicit commentary on any of the themes inherent within the FST principles.
As an employee of the program, I had worked on over a dozen Carrot on a Stick workshops since the program was launched. As such, I have a particular experience and insight into this intervention. The perspective I offer throughout the following section, however, is beyond my personal opinion. I have examined my experiences working within the program as a participant and observer, and by working with the principles, I am, as Ulrich (2003) describes, examining my professional claims and propositions. This is in keeping with the principle to select appropriate method/ologies, a commitment to communication and critical reflection is a methodological insistence. An evaluation is incomplete without reflection on oneās practice and is considered as vital as the views of participants that are routinely sought in conventional evaluation. I have attempted to distinguish my reflections on the application of the principles, from my interpretation of the other sources of information. The methods I employed to generate my reflection include the use of a Learning Journal where I recorded my experiences of the phenomena that have arisen throughout the study.
Picture 5.1 Program coordinator, Sarah Gosling.
Picture 5.2 Kids rock climb and abseil with Carrot on a Stick staff.
BE GENDER SENSITIVE
As we saw in Chapter 4, gender refers to the economic, social, political and cultural attributes and opportunities associated with being biologically male or female (Platform for Action 1995). In most societies, men and women differ in the activities they undertake, in access to and control of resources and in participation in decision making. Gender sensitivity can be seen as a continuity and reflexivity of attending to gender in research practice (McNamara 2009). Incorporating gender implications can be made intrinsic to all research processes, from developing the research question(s); exploring the implications of the findings, and embedding it in any advocacy for change based on those research findings (McNamara 2009). Gender sens...