Using participatory methods to develop context-specific local government actions to create healthy food and physical...

Childhood overweight and obesity represent major public health concerns globally, influenced by food and physical activity environments. In the absence of strong national or regional policies, there has been an increasing interest from local government jurisdictions to address obesity. This study aimed to apply three distinct participatory methods to engage different community groups in a medium size, socio-economically deprived municipality in Flanders (Belgium), to identify context-specific barriers and facilitators to healthy eating and physical activity from the perspective of these groups, and to propose locally relevant strategies.

We used group model building with actors (local government officials, health representatives, school representatives and youth workers), Photovoice with children and interviews with parents and teachers. An inductive-deductive approach was used to analyse the different outputs and combine the barriers and facilitators across groups in different themes.

In total, 15 actors participated in three group model building sessions, 66 children participated in five group Photovoice sessions, 14 children in one-on-one Photovoice sessions and 10 parents/teachers consented to an interview. Barriers and facilitators were identified across three themes: the obesogenic food environment (e.g. relative presence of healthy food outlets, supermarket proximity), the physical activity environment (e.g. an unsafe road environment discouraging active transportation, poorly designed play spaces) and the socio-economic environment (e.g. time and financial constraints for vulnerable groups, knowledge on poverty). By including the perspective of children and parents, actors could better understand the lived experience of their community and propose context-specific actions to tackle the identified barriers and facilitators. Proposed actions included offering healthy hot meals at school, attracting local markets to food deserts, designing car-free school streets, (re)designing playgrounds and increasing exchanges between community members and the local government.

This study demonstrates a promising approach to meaningfully engage different community groups in identifying barriers and facilitators for healthy eating and physical activity at the local level. By addressing the barriers and facilitators across multiple settings, local governments can take concrete steps towards creating healthier and context-adapted environments for future generations.