Q4: Live Outside the Box

How did the project come about?

Q4: Live Outside the Box is a unique campaign aimed at generating discussion and action in the community about childhood and adolescent overweight and obesity. Raising awareness about contributing factors helps to facilitate further action on the issue. Q4 creates supportive environments for parents to foster healthy behaviour changes in their children.

In June 2003 local representatives from relevant agencies were invited to the Central Coast Obesity Forum. Stakeholders agreed that facilities, policies and environments needed to change to overcome this complex problem. However, the Central Coast community was not yet aware that childhood overweight and obesity was so serious.

The Central Coast Obesity Awareness Working Group was formed to investigate programs for local schools that would impact on children’s daily eating and exercise behaviours, and also engage parents. Due to a lack of existing strategies, it was necessary to develop a new approach to the problem.

Project overview

Q4: Live Outside the Box was introduced to local schools in 2004. Based on a strong evaluation, enhanced Q4 competitions took place again in primary and high schools in Terms 1 & 2 of 2005.

Using existing strong relationships with local schools, school representatives were consulted during program development. The program was designed so as not to make extra work for teachers. Logos were designed to appeal to the target audience.

Central Coast schools were invited to involve students and their families in a fun program that encouraged and rewarded students for healthy eating and physical activity, and for limiting sedentary behaviour. Primary school children were each given a special ‘passport’, while high-school students received a set of ‘Challenge Cards’ mounted on a Q4 lanyard to record their activities.

At the end of the two-week activity, certificates were awarded to all entrants, with Q4 prize draws for students in each year and vouchers for sporting equipment for schools with the highest average point scores. Teachers received comprehensive resource packs. The campaign was also supported by an interactive website which included electronic copies of teacher resources and regular competition updates. Principals nominated a contact person to allow smooth implementation of the competition in their school.

A crucial aspect of the campaign was maintaining a media presence. ‘Q4 bites’, a series of questions and answers designed to get people talking about obesity, were distributed widely. Q4 bites appropriate to parents were adapted and used as radio advertisements. There was regular coverage on local TV, local radio and in print media.

Evaluation

Evaluation focused on student behaviour change, participation rates, media coverage, and teacher and parent feedback.

Following the success of Q4, and anecdotal reports of the effect Q4 had on children’s eating and activity behaviours in 2004, schools also collected information from the children’s passports in order to investigate this effect in 2005.

Over the past two years, 82% (65/79) of Central Coast primary schools have participated in Q4. In 2004 there were 17,000 students involved from 45 schools. In 2005, 57 schools entered a total of around 20,000 students.

Primary-school student passports showed that Q4 significantly improved healthy activities of students in all categories during the two-week competition (p<0.002 paired t-test: 2 sample for means).

A survey of 120 parents of participating primary-school students indicated:

• 88% were very involved in Q4
• 93% rated Q4 as ‘excellent’ or ‘good’
• 50% noticed children were watching less TV
• 44% reported children ate less ‘extra’ food
• 84% felt Q4 had made an impact on their entire family
• Families were leading a healthier lifestyle and doing more together.

The Q4 2-Week Challenge was offered to high schools for the first time in 2005. In that year, 3,000 Year 7 and 8 students from 12 of the 29 Central Coast high schools participated. Q4 significantly improved healthy activities of participating students in all categories during the two-week competition (p< 0.002 paired t-test: 2 sample for means).

Participating high schools are keen to enter the challenge in 2006 and increase the level of participation by students.

Participating students enjoyed the challenge, particularly increasing their physical activity.

What worked well?

Q4 has started the process of tackling childhood overweight and obesity on the Central Coast through:

• Prompting healthy behaviour changes in children and families
• Providing families with practical ideas and opportunities to improve healthy behaviours, and
• Providing reusable resources for schools to support education about healthy lifestyles.

What would be done differently?

Q4 has shown a few things about childhood obesity on the Central Coast:

• People want to be involved – participation rates and the support from local partners indicates that the community is concerned about this issue
• Children and adolescents love opportunities to be more active; however, limiting TV and computer use and ‘extra’ foods proved more difficult.

Where to now?

Q4 has established the benchmark for large-scale, practical programs addressing childhood obesity. Before Q4’s introduction into schools on the Central Coast there was a distinct lack of strategies in this area. The campaign is consistent with recommendations from the Obesity Summit NSW – Government Action Plan.

Consistent anecdotal evidence from teachers representing schools from across the Central Coast demonstrates Q4 is easily adapted into each school environment.

The review of Q4 demonstrates the project may have a higher impact when a local coordinator implements the competition, so this may be a prerequisite for moving Q4 into other areas.

The Q4 2-Week Challenge will be offered to Years 7and 8 in Central Coast high schools in 2006, with the focus on raising the profile in the school, linking it to the new NSW Healthy School Canteen Policy and increasing participation rates. Results will again be collected and compared with baseline data from 2005.

The Q4 passport concept will not be used in primary schools in 2006, as it has already run for two years. Primary schools are now keen to focus on more specific action and have nominated Q4 activities to focus on lunches brought from home, in order to support the Healthy School Canteen Policy. Q4 has generated great enthusiasm in parents and schools to look for other practical ways to improve healthy lifestyles of children. The lunchbox activity will be the first of many, run in close consultation with the school and broader community.

Summary

Q4 went so well because all the following elements were included. If you are thinking of running it in your area, these are the things you might like to consider if you have access to them:

• Strong relationships between schools involved in the project and the project organisers (the Health Promotion Unit and the Community Nutrition Department). Because of trust built up over time, schools generally gave the program their support.
• One person responsible for coordinating the program locally.
• Backing of local media – teachers said this was a great help. Keeping a profile in the media about how other schools were going helped tap into kids’ competitive nature.
• The support of local organisations – this helped to cover the cost of prizes.
• Funding: to cover funding now that the program and all resources are developed, it is recommended that for an area similar in size to the Central Coast you would need at least one full-time project officer.
• Being able to print resources, which can all be accessed via the website