Background
Communities play a critical role in addressing the childhood overweight and obesity epidemic. Community members, organizations, and governments make the decisions that affect land use, nutrition, marketing, community planning, transportation and ultimately the health status of their residents. Communities provide the context, environment, and opportunity for children to eat well and be physically active (CDC,2009). They are ideally positioned to provide resources, promote behaviors fostering change, and develop effective strategies to promote healthy eating, healthy lifestyles, and healthy weight. Recent research highlights the important role collaboratives can play in promoting physical activity (Litt et al.,2013).  In Georgia, little is known about the number of collaboratives at work or their readiness and capacity to implement evidence-based childhood obesity prevention strategies. In 2012, Georgia State University’s School of Public Health (SPH) partnered with the Georgia Family Connection Partnership (GaFCP) to identify local communities in Georgia that have existing capacity and interest in expanding childhood obesity prevention efforts. SPH and GaFCP assessed community readiness related to the existence of collaboratives, leadership, partnerships, community knowledge, and local resources. This study presents findings on the community readiness of 15 communities engaged in childhood obesity prevention efforts across Georgia.

Objectives
To  identify communities in Georgia that have an interest in expanding childhood obesity prevention efforts and assess their capacity and readiness for future implementation of policies and programs to address childhood obesity.

Methods
The Community Readiness Model (CRM) assesses the capacity to which a community is prepared to address an issue (Plested, Edwards, & Jumper-Thurman, 2006). The CRM has been applied to childhood obesity prevention and used to develop effective, culturally-appropriate, community interventions (Findholt,2007;Sliwa et al.,2011). The model is based on the Transtheoretical Model of Behavior Change and assesses six dimensions, including existing efforts, community knowledge of efforts, leadership, community climate, community knowledge of issue, and resources available to support efforts. The model includes prevention/intervention strategies for each stage of readiness.  Fifteen collaboratives across Georgia were identified in this study. Collaboratives with moderate to high levels of interest were included.  Collaboratives that existed within the last three years and were previously active were also included. Seventy-nine key informant interviews were conducted (4-6 interviews per collaborative) using a semi-structured questionnaire assessing the six dimensions of readiness. The key informants represented different sectors of the community (e.g., healthcare, education, community organizers, and policymakers). Data were analyzed using qualitative methods and the CRM scoring system. Researchers discussed and reconciled differences in scores and reached consensus for each dimension. An overall stage of readiness score was reached for each collaborative by taking the total of all calculated scores and dividing by the number of dimensions (6).

Results
Overall, total readiness scores ranged from 2.8 to 5.1 out of 9. Ten out of 15 communities scored in the Preplanning stage (clear recognition that something must be done; efforts are not focused or detailed). One community scored in the Denial/Resistance stage (there is little recognition that the problem is occurring locally); two communities scored in the Vague Awareness stage (a local concern, but no immediate motivation to take action); and two communities scored in the Preparation stage (active leaders with modest support of efforts). The average score across all collaboratives for community efforts was 6.3 (Initiation Stage), community knowledge of efforts was 3.5 (Vague Awareness Stage), leadership was 4.6 (Preplanning Stage), community climate was 3.1 (Vague Awareness Stage), community knowledge about the issue was 3.5 (Vague Awareness Stage), resources available was 5.1 (Preparation Stage), and total average score was 4.3 (Preplanning Stage).

Conclusions
In Georgia, only 15 out of 159 counties have established collaboratives dedicated to childhood obesity prevention. Efforts were not always coordinated, widely supported, or adequately publicized.  This was reflected in the lower scores in community climate and community knowledge. While many decisions related to nutrition and physical activity are made at an individual level, this is only one piece of the puzzle.  Individuals can only make healthy decisions when they have the resources, environments, and opportunities to do so.  Communities can respond to the obesity epidemic by creating environments that support healthy eating and encourage physical activity.  Evidence supports the efficacy of community involvement in promoting healthy eating and active living, which ultimately benefits the health of residents. The state has a growing number of communities with interest in childhood obesity prevention and many have expressed a need for support on effective approaches. There is a need for state action to catalyze efforts to support the establishment of additional collaboratives and build capacity to implement childhood obesity prevention programs and policies.

Implications
This study has demonstrated the utility of the CRM for understanding community capacity on childhood obesity prevention. Four of the collaboratives subsequently received grants from the Healthcare Georgia Foundation to implement childhood obesity prevention initiatives. GSU and GaFCP are providing technical assistance for implementation of their childhood obesity prevention policies and programs.

References

1. Centers for Disease Control and Prevention. Recommended Community Strategies and Measurements to Prevent Obesity in the United States. MMWR 2009;58 (No.RR:07).
2. Litt JS, Reed HL, Tabak RG, Zieff SG, Eyler AA, Lyn R, et al. Active Living Collaboratives in the United States: Understanding Characteristics, Activities, and Achievement of Environmental and Policy Change. Prev Chronic Dis 2013;10:120162.
3. Plested B, Edwards R, Jumper-Thurman P. Community readiness: a handbook for successful change. Fort Collins (CO): Tri-Ethnic Center for Prevention Research; 2006.
4. Findholt N. Application of the community readiness model for childhood obesity prevention. PH Nurs 2007, 24(6):565–570.
5. Sliwa S, Goldberg JP, Clark V, Collins J, Edwards R, Hyatt RR, et al. Using the community readiness model to select communities for a community-wide obesity prevention intervention. Prev Chronic Dis 2011, 8(6):A150.

Support / Funding Source
The Healthcare Georgia Foundation funded this study.