Abstract
Background: Low socioeconomic status (SES) communities in New Zealand (NZ) bear a disproportionally high burden of nutrition-related non-communicable disease (NCD) (1). The Māori population in New Zealand is one of the ethnic groups which suffers high deprivation and is heavily burdened by complications of overweight, obesity, cardiovascular disease and diabetes (2, 3). Public and private sector organisations, including government, are implementing programmes within communities to improve the health and well-being of New Zealanders. For these programmes to have a lasting positive impact on health outcomes, programmes need to be planned, developed, delivered and evaluated using best-practice evidence-based sustainability frameworks. Involving community members in the planning, development and delivery of community health programmes is recognised as an effective strategy. However, programme providers need a range of inputs to achieve their public health-related goals. Primary health, corporate, social enterprise and non-government organisations also make a major contribution to improving the health of communities. With the current economic climate increasing pressure on budgets and greater public interest and scrutiny of health investment decisions, understanding how to support sustainable programmes is essential.
Objective: The aim of this study was to investigate programme providers’ perspectives of the major enablers and barriers to the long-term sustainability and effectiveness of community-based nutrition wellness programmes, and to determine whether an existing evidence-based sustainability assessment tool is applicable for use in a low SES NZ community.
Design: This study used qualitative methods to understand providers’ perspectives of the factors that influence the sustainability of their Porirua region based programmes. At the time of this study Porirua had high levels of deprivation as classified by the New Zealand Index of Deprivation, this made it an appropriate region to target (4). A grounded theory approach was used to assess the fit of an existing model to the recruited programmes. A total of 23 programme providers were recruited from 21 programmes. Semi-structured, face-to-face and telephone interviews exploring factors influencing sustainability were conducted with each programme provider. All interviews were recorded and transcribed verbatim. Data from the written transcripts were analysed using general inductive analysis. NVivo 11 Qualitative Data Analysis Software was used to organise the data into nine main themes and linked sub-themes.
Results: The results report nine major factors impacting on the sustainability and effectiveness of community-based nutrition wellness programmes in Porirua. Three key factors which developed from the data appear to have the largest impact on programme sustainability. These are partnerships, funding stability and community engagement. The remaining six factors were identified as important, however, were interlinked with the three key factors and with each other, and therefore do not represent major independent influencing factors.
Conclusion: The major factors influencing the sustainability of formal and informal community-based nutrition programmes in Porirua, align with factors identified in the literature. All domains of the Program Sustainability Assessment Tool (PSAT) are relevant in lower SES NZ communities. However, an additional factor and a hierarchical ordering of factors are recommended to enable the tool to be used effectively in NZ. These recommendations are presented as a modified programme sustainability assessment framework relevant for use in lower SES NZ communities.