With increasing cross-national collaboration and integration, complex societal problems – such as the childhood obesity epidemic - demand international societal collaborations and fields of expertise. Setting up a consortium of organisations with complementary expertise that can work together and support potential solutions to specific complex societal problems is one way of operationalising this. Below is some experience based advice, outlining important things to consider when setting up and running such consortia:

Agree on an equitable distribution of work and responsibilities. This should be set out in the work plan before starting up, outlining the who, what, when, and how with as much detail as possible, including leadership of the different streams of work. Make sure to revisit the plan as the project unfolds and adjust as appropriate.

Have a transparent management structure - Have a clear structure for decision making, and discussing items as they come up, and communicate this regularly.

Make internal communication a priority - There will always be changes in staff in a large project, so keeping the flow of information going is worth some extra attention.

Have a plan for reporting and stick to it - Reporting is necessary to make sure the project is on track to deliver what it was set up to do. The scope of reporting should be complementary to the complexity of the project, and manageable to keep up with for consortium partners.

Provide support - International projects are labour intensive, and you will soon experience that the schedule and workload of your partners are filling up. Support for providing project deliveries is valuable, including clear communication of what is needed and when, and process tools if possible.

Have some fun!

Engaging adolescents in participatory action research (PAR) approaches may be ethically challenging. Body weight is a sensitive issue in adolescent years, and adolescents not familiar with research methods may feel coerced to participate in the research or may experience pressure from stakeholders. CO-CREATE developed ethical recommendations to mitigate some of the potential PAR challenges:

● Do not select youth based on physical appearance or weight status

● Give youth time to think about their participation and ask for their consent; and make it clear that they can withdraw at any time if they so wish

● Do not plan for research activities colliding with school obligations; do not overload the youth with tasks

● Provide youth with information that is unbiased and accurate

● Do not use stigmatizing language and do not tolerate bullying

● Encourage discussions on obesity at a structural level rather than individual

● Handle personal information confidentially and explain how it is handled and stored

● Train youth in ethics and the management of written and visual material

● Inform stakeholders about conditions for interaction with youth; require their commitment to treat youth respectfully

● Encourage youth to seek protection if needed

● Report suspected abuse or maltreatment to relevant national authorities



For more information, visit www.co-create.eu

Across Europe, one in every seven adolescents aged 15 years old is living with overweight or obesity. By 2025, overweight is expected to affect one in every 5 children. Addressing obesity during adolescence is particularly important as many studies have found it to be more predictive of obesity during adulthood. However, the lack of positive improvements suggests that more studies are needed to find effective prevention strategies for obesity targeting this age group. 

While adolescents are recognised as an important target group for obesity prevention strategies, there are few examples of adolescents themselves being included as active agents formulating strategies. However, changing the obesogenic system for - and more importantly, in collaboration with – adolescents across Europe should be a key strategy to reduce obesity prevalence and the related burden of obesity. While youth engagement is key, CO-CREATE also recognises the need to ensure that such involvement is positive. The review of youth-oriented literature and guidelines allowed us to identify four central mechanisms to promote youth engagement: 

1. Unfreeze the culture and recognise the need for a cultural shift  

2. Catalyse knowledge into action by nominating champions 

3. Internalise change by creating and taking advantage of existing opportunities 

4. Institutionalise youth engagement into policy and standards to ensure it becomes a consistent practice  

 

To learn more about CO-CREATE, and the Healthy Voices youth advocacy platform visit https://www.fhi.no/en/studies/co-create/youth-involvement/

Today, young people under the age of 25 represent the largest part of the world’s population. As our next generation of leaders, policymakers, and workforce, we need to ensure youth health is a focal point of developed policies. True and lasting impact to positively influence youth health, including overweight and obesity, will not only need to include young people’s input, perspective, and suggestions: the leadership of young people themselves need to be part of the answer. For this reason, the World Obesity Federation has created as part of the CO-CREATE project and our collaborator project, Science and Technology in Childhood Obesity Policy (STOP), a website that provides young people with the necessary knowledge and advocacy tools to promote their positive engagement to address health-related challenges. 

 

Healthy Voices simultaneously exploits the results from both European projects and sustains positive youth engagement. It is an educational and capacity-building platform for change-makers to share insights via blogs and to cultivate discussions. It aims to provide young people with some tools and expertise about how to become actively involved in shaping their environments and become agents of change.



To learn more about CO-CREATE, and the Healthy Voices youth advocacy platform visit https://www.fhi.no/en/studies/co-create/youth-involvement/

The data management plan (DMP) includes guidelines on providing high quality data for the project. Guidelines have been created and implemented throughout the process of data collection, handling, and storage. They mainly involve the interview and dialogue data as derived from the youth alliance groups, and have been created in cooperation with the University of Amsterdam. All data from the alliances are anonymised and thereafter transcribed and coded according to the guidelines for qualitative data analysis. The University of Oslo collects the quantitative data for all member countries, through electronic questionnaires utilising a digital system called Survey Exact. This system contains a comprehensive codebook, which all data is run through. After the initial analysis, the data management centre performs agreed cleaning procedures, which include checking for consistency with guidelines. The value derived from this process will be the coded end-data. The process ensures that the data is comparable across the different groups and countries, creating opportunities for researchers to conduct analyses, both of qualitative and quantitative nature. The main practical recommendation derived from this DMP is the development of detailed procedures for data collection and interview guides, and the development of questionnaires that ensures comparable data. The benefits for the end user are detailed guidelines for correct management and storage of data, ensuring all relevant parties apply the same measures and procedures, which in turn creates comparable end-data and protects the anonymity of the youth involved.

Microsoft Teams is an online hub which simplifies multi-institutional cooperation. It allows users to have online meetings and to store, share and work simultaneously in documents. A team consists of owners (administrators), members, and guests. When creating a team, the team is located on the server of the owner’s affiliated institution. Individuals from the same institution are members, while individuals from other institutions are guests. Members have a few more options in Teams than guests, such as the possibility of uploading apps and creating private channels. It is however possible to give guests these same options. For CO-CREATE, we have created a team for the youth alliances with eight channels. All data are initially uploaded in the general channel. After the data has been uploaded, it is coded and handled by the University of Amsterdam. After coding and commenting, the documents is reviewed and revised by the country concerned. When the UvA and the respective countries agree on the final version of a document, the document is considered completed and moved to the country specific channel. All documents that are worked on are in the general channel, while all documents in the country specific channels are finished documents. If all members in a project actively use Teams as their work- and storage-platform, any problems pertaining to institutions having different versions of the same document is bypassed. The built-in communication channels and message boards lay ground for more efficient international- and multi-institutional communication within a project. Experience have shown that the threshold for asking questions is lower on a message board than on telephone or e-mail, which in turn may save time on revisions when cooperating.

System Dynamics is a scientific approach based on modelling, simulation and analysis that may facilitate our understanding of the dynamic behaviour produced by complex systems such as the one governing obesity. It allows for policy development, the implementation of interventions and for impact assessment in the context of obesity. Simulation models provide low-cost laboratories for learning. A virtual reality is created, and in that substitute policies and interventions may be tested with no delay in a risk-free environment. Controlled experimentation becomes feasible. As such, system dynamics may be considered an important vehicle for policy design and assessment studies.  CO-CREATE applies a system dynamics approach to understand and address adolescent obesity. In previous stages of the project, diagramming methods, such as systems maps or causal loop diagrams, have been created in collaboration with adolescents and policy makers to gain insights into how obesity mechanisms may operate. This approach in useful when identifying high leverage/low cost policy options. All the variables represented in the systems map and their interrelationships must be uncovered and described in a formal, computable form, so as to allow for simulation. The resulting system dynamics model is a formalized synthesis of the knowledge generated in a participatory process with stakeholders and existing evidence from other sources. It constitutes a knowledge repository that may be subject to formal, simulation-based analysis and that forms the basis for a gradual, experience-based improvement of the knowledge upon which co-created policies are based and acted upon. 

The Dialogue Forums provide youth with an opportunity to discuss and refine their policy ideas with relevant stakeholders, such as policymakers and business representatives. The model includes comprehensive guidance and resources on how to plan, execute and follow-up multi-actor dialogues, including a Guidebook and a Resource Library which serves as a central repository of all the resources and templates needed for the process. The discussion itself is structured around a pre-defined set of activities meant to unpack the policy idea and gather feedback from participants. Recognizing some of the new barriers caused by COVID-19, a physical and digital tool have been developed to facilitate in-person and digital Dialogue Forums. The model has been developed to facilitate policy discussions between generations and sectors, putting youth at the forefront of this process. It includes key characteristics that policymakers and practitioners seeking to host policy co-creation dialogues with youth should consider, including:  involve youth in the planning process, including identifying relevant stakeholders and logistical planning; be transparent with youth and other participants about how the input shared at the Dialogue will or will not be used; aim for 50% youth representatives and 50% adult stakeholders to mitigate power imbalances; aim for diverse youth representatives; provide youth with the opportunity, and appropriate training, to facilitate and take an active role in the discussion; give everyone at the table equal opportunity to share their unique perspectives. These characteristics enable youth to be active contributors and champions of the Forums and their policy ideas, and to be better equipped to drive policy action

As part of CO-CREATE, EAT developed a new multi-actor Dialogue Forum model to drive the empowerment of youth through meaningful dialogue with relevant stakeholders about youth-led obesity-prevention policy ideas. The Dialogue Forum model was created through a design-led development process including research, prototyping and production, followed by additional testing and refinement. The research consisted of semi-structured interviews and workshops with youth and relevant stakeholders in Norway, and gathered insights demonstrating various challenges with youth inclusion in policymaking: policymakers do not take youth seriously, but neither do teachers nor parents; policymakers think all youth are the same until they see them disagree; sharing personal stories is a powerful tool, but it makes youth vulnerable; youth are often invited, but not heard; the purpose of the invitation to youth is unclear; policymakers or other stakeholders often do not follow up with youth after a meeting.  

The research insights guided the development of key design principles for the Forum model, to ensure a meaningful dialogue across generations and sectors. The principles for meaningful youth participation in the General Comment on Article 12 of the UN Convention on the Rights of the Children were also incorporated into the design of the model. Feedback from tests of an initial model at international events and with various audiences led to the refinement of a comprehensive Dialogue Forum model for establishing, executing and following-up on multi-actor dialogues, including various resources and tools for organizers.  

Amidst the current COVID-19 pandemic, the Portuguese Youth Alliance Members were forced to stay at home, with schools closed and all the activities suspended between March-August 2020. To sustain the progress of the alliances, an online approach was established to maintain regular communication with the youth. The WhatsApp online platform was the main communication channel allowing for almost daily contact, where meetings were scheduled and some queries, needs, and feedback were shared. Several online meetings were conducted with a very high level of attendance and engagement by the Youth Alliances. Apart from the meetings envisioned in CO-CREATE, an additional format of meetings was introduced, where young people openly shared their questions and ideas to young professionals with experience in several fields related to the policy ideas. In these Q&A sessions, two nutritionists, a physical activity expert, a psychologist, and a member of youth organisations helped to discuss and strengthen the proposals. To further support the youth’s research, four E-books on the related topics were provided. By the end of July, a digital discussion with stakeholders took place, confirming once more the excitement of the Portuguese Alliance Members on moving forward with their ideas.

The Portuguese CO-CREATE coordinating team is delighted to have been witnessing the youth alliance members swift adaptation and remarkable dedication to the project, without compromising its objectives and progress even during these challenging times

For more information, visit www.co-create.eu.

Participatory Action Research (PAR) is an approach to conducting studies that originated as a critic towards a more conventional top-down research approach where ‘expert outsiders’ are studying ‘research objects.’ Instead, people and communities are partners in defining and conducting the research together with academic researchers. Generally, the research addresses the actual needs of people and communities. PAR relies on the iterative process of research where participants are empowered and provided with the foundation to enable research-based action and enact actual change. In CO-CREATE this crucial transfer is done through providing training and facilitation for young people to further understand their own lived situation and make use of their situated knowledge. These knowledge and skills are then translated to action, specifically in the CO-CREATE context, for young people to develop policies to address the challenge of adolescents’ obesity relevant to their daily life.

PAR that is led by youth, such as the one being implemented in CO-CREATE, is commonly known as YPAR (youth-led participatory action research). In this context, It is an effective tool for youth to address inequalities on various social issues, particularly those that are directly impacting them, including health, as well as successfully promote civic and political engagement among youth. The reasons to involve youth in participatory action research are 1) the idea that those impacted by the policy should be involved in policymaking and youth are generally under-represented, 2) involving youth in policies that addresses their lives enhances the fit of the policy to their lives and strengthens the legitimacy of policies.

Youth participation is increasingly praised in a variety of public policy areas. Ambitious participatory processes are known to be more likely to reflect the voice of youth in public policy. However, recruiting young people for ambitious participatory processes is not easy, especially to ensure that a diverse group of youth take part.  

 

The CO-CREATE project is committed to include underrepresented youth in its participatory process. To date, the project has recruited 15 groups of 16-18-year old to take part in a whole school-year activity geared towards contributing policy ideas for the prevention of childhood obesity. These policy ideas are then tested in real context in 12 municipalities across five European countries (the Netherlands, Norway, Poland, Portugal, and the United Kingdom). To ensure that a group of diverse, and usually underrepresented young people are actively invited to join, the CO-CREATE Consortium designed a youth recruitment protocol, in collaboration with the local partners and youth organizations. In particular, the CO-CREATE youth recruitment protocol builds on a pre-recruitment investigation (‘fieldwork preparation’), carried out in the five countries, in order to identify, in the respective contexts, which sections of youth were likely to be under-represented and the most suitable channels to reach out and secure their participation. The recruitment protocol also addresses the ethical requirements involved in youth led participatory action research applied to health promotion.



Read the protocol for youth engagement, developed as part of CO-CREATE here https://www.fhi.no/contentassets/0a74196d35c64da89d337e25af982f5f/co-cr…

The CO-CREATE youth engagement approach is built on the principles of youth led participatory action research (YPAR) where young people in CO-CREATE youth groups, called alliances, are facilitated to take the active lead in developing policy ideas to address the challenge of adolescents’ obesity.  

To ensure high level of support for young people, each alliance is assisted by facilitators and co-facilitators. CO-CREATE facilitators are members of CO-CREATE consortium who have had prior experience in working closely with young people. The co-facilitators are youth workers or recruited from youth organizations and tend to be closer in age to the youth in alliances. Their role is to support the facilitation but also to act as peers to the young members. The facilitators and the co-facilitators followed a training program prior to their work with the alliances in their respective country. The facilitator training was aimed to familiarize the facilitators with the core CO-CREATE methodology such as YPAR, system mapping, and photovoice. The training also touched on the “how to” of youth facilitation, as well as on the research aspect of the engagement project that was built on qualitative methodologies. The co-facilitators’ training covered topics such as YPAR minute making, advocacy training, vlogging, and peer recruitment. The last three topics are intended for the co-facilitators to in turn deliver in the form of a training to the young people in the alliances. These two sets of training are instrumental in providing adequate and constructive support to ensure active engagement from young people in a participatory approach. 



For more information, visit www.co-create.eu.  

CO-CREATE frames adolescent obesity as an outcome of a multitude of interlinked factors, and methods to account for this complexity are essential in obesity research. We used ‘group model building’ (GMB) with youth in Poland, Portugal, The Netherlands, Norway, South Africa, and the United Kingdom to generate data on their perceptions of the drivers of adolescent obesity. GMB is a participatory research method that guides participants through collaborative discussion to generate a visual representation of complex issues with many interconnected elements, and how they are related causally. Drawing on systems thinking, GMB recognises the inextricable links between different actors and an array of factors in any given system. Applied in community settings, GMB has been used widely with members of the public and is carefully designed to be easy to follow under the guidance of an experienced facilitator. GMB is a method which carefully abstracts the individual to explicitly represent system-level drivers of the challenge; this made it particularly apt for asking adolescents to discuss the potentially sensitive topics of diet, physical activity, and body weight. The results from the CO-CREATE GMB workshops are a set of ‘causal loop diagrams’ (CLDs), which illustrate factors the young participants perceive to drive adolescent obesity. They illustrate these numerous drivers and, via arrows, how they are linked causally. By exploring and representing the complexity of obesity, CLDs facilitate the development of potential interventions, as is being done in further stages of CO-CREATE.



For further results from the CO-CREATE project and the review of available research evidence, visit www.co-create.eu

CO-CREATE is using a complex systems approach to addressing the challenges presented by obesity The approach helps articulate the need to span a range of political, social, cultural, economic, and other domains within any given system. We conceptualise obesity as an outcome of many, interdependent factors, and people within a connected whole. A ‘system mapping’ method called group model building (GMB) was used to represent adolescent perceptions of the drivers of diet and physical activity. We produced causal loop diagrams using GMB with adolescents in Poland, Portugal, The Netherlands, Norway, South Africa, and the United Kingdom. Beyond the drivers that were relatively expected such as food advertising, access to unhealthy foods, and lack of physical activity, young people mentioned the role of mental health, screen time, social media, and body image pressures, as important contributors to adolescent obesity. The causal loop diagrams generated with the young people provided insights into potential leverage points in the system where interventions may be most effective; they formed the basis for CO-CREATE Youth Alliances in which young people developed policy responses that take a systems approach to the problem of adolescent obesity. The maps will also be further used to help generate a systems dynamics model showing the potential impact of the novel policy responses to adolescent obesity. Using complex systems thinking with young people, to explore policy-amenable drivers of adolescent obesity has helped create a more thorough, robust picture of the influences on diet and physical activity.



For further results from the CO-CREATE project and the review of available research evidence, visit www.co-create.eu

A review of the research evidence summarizing effective interventions targeting overweight and obesity among adolescent showed little or no effect on body mass index, or physical activity levels of adolescents, while results from a few reviews suggest possibly beneficial effects of public health interventions on dietary behaviours (i.e. consumption of sugar-sweetened beverages). There is limited evidence of interventions directed towards the wider community.

The review revealed that there is limited evidence of differential effects of interventions on adolescents from different socio-economic groups. The review concludes that the evidence-base for the effectiveness of interventions to prevent overweight and obesity in adolescents is weak. Also, besides, the body of evidence is incomplete, since most included interventions targeted the individual and were set in schools, while structural and environmental interventions applied in the wider society were lacking.

There is a need for:

1. Effective and coordinated policy responses targeting inequalities both in overweight and obesity as well as in the social determinants of health.

2. A new understanding of the associations between overweight and obesity prevalence among adolescents and the impact of national policies.

3. High-quality evaluations of the effectiveness of structural and environmental interventions targeting overweight and obesity among adolescents.

4. Studies on differential effects of interventions targeting overweight and obesity among adolescents from different socio-economic groups.



For further results from the CO-CREATE project and the review of available research evidence, visit www.co-create.eu

Physical inactivity is the fourth leading risk factor for death globally, and a major cause of the global rise in both non-communicable diseases (NCDs) and overweight and obesity. To help governments take more action, World Cancer Research Fund International has as part of the CO-CREATE project developed a policy framework, MOVING.

 

The framework consists of six overarching policy areas, which were identified through a global literature review, thematic analysis and consultation with physical activity policy experts.

M - make programmes, opportunities and initiatives which promote physical activity; O - offer training in physical activity promotion across multiple professions; V - visualise and enact active design guidelines for structures and surroundings; I - implement urban, rural and transport plans that support active societies; N - normalise and increase physical activity through public communication that motivates and builds behaviour change skills; and G - give physical activity education, assessment and counselling.

 

The MOVING framework forms the structure of the MOVING database, which is used for reporting, categorising, monitoring and promoting a range of government policy actions that increase physical activity. The framework and database can help identify actions needed for specific populations, enable researchers and civil society to monitor what governments are doing, benchmark progress and hold governments to account.  



Learn more about the MOVING database, created as part of CO-CREATE at https://www.fhi.no/en/studies/co-create/news2/moving-was-launched/

Levels of obesity and diet-related non-communicable diseases (NCDs) continue to increase in Europe. In response, national governments have implemented various nutrition and physical activity policies such as taxes on sugar content in foods or drinks and programmes to encourage people to walk and cycle more.   

  

As part of CO-CREATE, World Cancer Research Fund (WCRF) International has developed two new tools that will help assess countries’ performance by benchmarking attributes of nutrition and physical activity policies. The benchmarks were developed based on research evidence and expert advice, and follow the structure of the NOURISHING and MOVING frameworks. They consist of a series of indicators that compare existing government action with a series of aspirational policy attributes relevant for each policy area.  

  

The tools will be applied to policies in WCRF International’s database of nutrition and physical activity policies. The benchmarks will highlight any gaps in policymaking and avenues for improving existing nutrition and physical activity policies. Furthermore, they will enable comparisons between countries and produce an overall illustration – or country index – of the status of nutrition and physical activity policies, which will allow us to assess progress in government action to decrease levels of obesity and diet-related NCDs across Europe.  

  

Learn more about how CO-CREATE contributes to the evidence and infrastructure for local and national policy changes at https://www.fhi.no/en/studies/co-create/policies/

The UN Child Rights Convention states that all children have the right to be heard in questions affecting their lives. From a child’s right perspective, they need to be included in projects and processes that seek to find advantageous and effective solutions to societal problems and challenges that affect them. Only young people themselves know what it is like to be young today. When carving out interventions targeted at young people directly, we are more likely to reach successful outcomes if we identify solutions with them. There is an argument for involving youth as a means for strengthening democratic participation; being able to have a say in decision-making is empowering and has a potential lead to lifelong engagement in democratic questions. To increase satisfactory youth participation, consider the following steps:

Inform - Give adequate and understandable information on the topic, and process in which they will be involved.

Independence - Young people should be able to come together independently, to learn more about a topic and agree on solutions and positions. Consider involving youth that are members of, or represent, youth organizations.Continuity and wholesome processes - Youth participation is a process. Youth should therefore be involved over longer periods, and in all phases of the process and/or project rather than as a one-time event. Timing-Young people are busy with school and other activities that are important for their futures. Accommodate for this when involving young people. Real influence - Real and meaningful youth participation entails that included youth have room for actual influence. Provide open information on when and where decision-making will happen and any plans for follow up that they can engage with.

To generate healthier food and physical activity environments, and in turn sustainably foster healthier weight in children and adolescents, we need to move away from our current focus on individual-level interventions. We must strive coherent policies aimed at making healthy choices the easiest and preferred options in a society of overabundance. CO-CREATE will contribute to this ambitious goal by:

1.Developing tools and methodologies for monitoring, benchmarking, and evaluation of policies

2.Collaborating with adolescents across Europe to develop novel policy options that will contribute to the overall objective of prevention of, and reducing social inequalities in, overweight and obesity. Over a five-year project period. CO-CREATE will:

●Develop and update databases including implemented policies that directly or indirectly influence food and physical activity behaviours

●Develop a system for benchmarking the policies included in the databases

●Expand knowledge regarding policies that effectively target adolescents

●Investigate changes in overweight and obesity in relation to relevant policies in European countries

●Explore potential differences related to the socio-economic background of adolescents

●Make system maps to identify factors that alone or together influence healthy choices with adolescents

●Collaborate with adolescents to develop novel policy options

●Establish and evaluate dialogue forums with adolescents and other stakeholders from the public and private sector

●Develop and test a model to assess and predict the potential impacts of selected policies

●Generate capacity building tools

All results from the project are published on www.co-create.eu .