Food & Fitness RAP

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About RAP

Food & Fitness for Children and Families: A Rapid Assessment Tool is a field guide targeted at community-based organizations, health workers, researchers, educators and other individuals interested in better understanding the contextual and environmental realities of childhood overweight and obesity. The Food and Fitness RAP manual and the complementary RAP training practicum provide users with tools that will allow them to collect information about the assets, challenges, perceptions and ideals related to those affected by childhood obesity.

The Food & Fitness RAP employs basic anthropological methods such as observation, interviewing and focus groups. The Food & Fitness RAP is “rapid” because of its emphasis on the language, social environment and cultural orientation of the users and communities in which the RAP method is employed. Data is collected by using anthropological methods and by wording questions in a way that is meaningful to the people who are being interviewed. In order to attain this cultural orientation, the RAP should be familiar with the general cultural environment. To use the RAP, the user should have an understanding of the language and culture of the community in which they will be collecting information.

The Food & Fitness RAP is a vehicle through which communities and academic institutions or university based researchers can build partnerships in order to address the topic of interest. For individuals not formally trained in anthropology yet interested in becoming more knowledgeable about the methodology, there are supplementary materials on the research methods available in a complementary Food & Fitness RAP manual , and in numerous publications on anthropological methodology. The RAP practicum provides a detailed discussion about the techniques introduced in the Food & Fitness RAP manual and includes examples and exercises to assist with the exploration of issues related to childhood overweight and obesity.

Staff

Susan C. Scrimshaw, PhD
Principal Investigator

Noel Chavez, PhD, RD, LD
Co-Investigator

Myrtis Sullivan, MD, MPH
Co-Investigator

Janel Heinrich, MPH, MA
Co-Investigator/Project Director

Robyn Wheatley, MPH
Research Assistant

History

The Rapid Assessment Procedures (RAP) methodology that the Food & Fitness for Children and Families: A Rapid Assessment Tool is based on was originally de­veloped over 20 years ago for the United Nations University Research Program in order to improve understanding of the successes and problems related to the implementation of the recommendations of the Alma-Ata Conference. The Alma-Ata Conference defined primary health care (PHC) as "essential health care made accessible to individuals and families in the community by means acceptable to them, through their full partici­pation, and at a cost that the community and the country can afford."  Most of the recommendations produced by this RAP relate to nutritional improvement, and em­phasize health promotion and disease prevention rather than the curative services that tend to be the primary concern of national health care delivery systems.

The Alma-Ata report also stated that promotion of primary health care activities "requires a close rela­tionship between the primary health care workers and the community." There is, however, great variation among countries in the extent to which this sug­gestion has been implemented. Since there is some evidence that community involvement is a prerequi­site for the success of most PHC activities. The RAP methodology encourages users to engage with the community to identify problems and develop solutions.

In the years since the original RAP manual was produced, new health problems have emerged.  RAP manuals have been modified for use with many health problems. These include AIDS, seizure disorders, water and health, diarrheal disease, reproductive health and aging.  RAP exists in many languages (e.g. English, Spanish, French, Portuguese, Chinese, Arabic, Turkish, Indonesian).

In 2003, the American Public Health Association (APHA) developed a toolkit for parents, teachers, students, and community leaders to use to prevent and control childhood overweight and obesity.  The APHA states that the public health community needs to make sure that children live in an environment that encourages healthy eating and physical activity and that families, schools, communities and researchers need to work together to promote healthy environments that support the following recommendations:

• Follow the U.S. Department of Agriculture’s Dietary Guidelines for healthy eating, www.health.gov/dietaryguidelines;
• Encourage children to eat only when hungry;
• Persuade children to be physically active, i.e. 60 minutes of moderate physical activity four days of the week;
• Reduce the amount of time children spend in front of the television, computer or video games;
• Plan family and school activities that provide everyone with exercise and enjoyment.

“The most important factor in keeping children healthy is letting them know that they are loved, appreciated and valued just as they are”.

(American Public Health Association, Getting in Shape for the Future: Healthy Eating and Active Living Toolkit. Accessed December 15, 2005, at http://www.apha.org/NPHW/2003/toolkit/PHW03-toolkit_rev.pdf)

These calls for attention to the health and fitness of children and youth are today’s equivalent of the Alma Ata declaration which inspired the first version of the RAP manual.  At this time, it is highly relevant to have this revised version, which focuses on a major and continually emerging threat to health--obesity and lack of exercise among youth.

In 2004, The Robert Wood Johnson Foundation (RWJF) commissioned this version of RAP, to focus on childhood and adolescent obesity prevention through understanding factors related to food and fitness in children and adolescents from community and culturally appropriate perspectives.  The intent of this current version is to go beyond the perspectives of health professionals, nutritionists, physical education specialists, teachers, policy makers and others and understand the beliefs, feelings, attitudes and behaviors of children, adolescents and their families regarding food and fitness.  This understanding must be combined with professional knowledge and approaches to create programs which are culturally and individually acceptable and practical.

During the development of the Food & Fitness RAP, a wide community of researchers, educators, students, health professionals, policy makers and youth were consulted through meetings, focus groups and interviews. Two groups in particular were essential to this effort:  Members of CLOCC, (the Consortium to Lower Obesity in Chicago Children) and the children and youth of the Chicago schools participating in The RWJF funded Health Professional Partnership Initiative (HPPI) project at the University of Illinois at Chicago School of Public Health.  These students assisted in producing the Food & Fitness RAP manual as junior researchers, helping us understand how to learn from them.

We hope that the resulting handbook will be useful to all who are working to improve the health of children and youth around the world.

Application

The RAP methods are concerned specifically with understanding the beliefs and perceptions regarding health and fitness, the preven­tion and treatment of overweight and obesity, and the utilization of multiple community and individual resources to maintain healthy weight and fitness in children and youth. There is no prescribed manner in which the methodologies or data collection checklists described in the Food & Fitness RAP manual should be used. It is important that Food & Fitness RAP users define their own research objectives, develop project-specific research questions, determine the necessary indicators, and prepare the data collection instruments accordingly.

RAP provides community-based organizations, health workers, researchers and social scientists, teachers and interested community members with guidelines for conducting rapid assessments of individuals’ health-seeking behavior; behavior involved in maintaining health and overcoming ill­ness. While, RAP is based on anthropological methods, one does not need an advanced degree in anthropology to use the RAP manual. However, one does need organizational skills and, most important, the ability to develop rapport with people and to ac­curately record and transmit their views, beliefs, and behaviors.

The RAP manual was originally intended for use by persons already trained in anthropological or related field methods. However, since RAP was originally developed, many individuals without prior experience using anthropological or qualitative field methods have used the RAP methods to address issues salient to their communities.  The RAP manual provides myriad data collection checklists found in Appendix A (Data Collection Guide). This guide provides a variety of sample questions, outlines, checklists, grids to complete, and other data-gathering aids. Each checklist is designed primarily for short periods of data col­lection, in the range of four to eight weeks, but can easily be expanded for longer-term application, resources permitting.

The Data Collection Guide (Appendix A) is grouped in five categories: community (C), household (H), neighborhood (N), school (S) and primary health care providers (P). The guide is intended to help focus the research, or­ganize the data collection process, and standardize the information gathered. It should be used as an outline for the formulation of questionnaires, checklists, and other data collection instruments. When using this guide it is important for users to remember that questions do not need to be worded exactly as they are in the checklists. Each checklist is intended to be adapted to the needs of the project and the communities of interest, in an attempt to collect a manageable amount of data. Collecting unnecessary data can be distracting and time-consuming. Some of the checklists are quite detailed. Select only those, or parts of those, that relate to the study at hand. Others are quite general; they can be ex­panded. New instruments may need to be developed or located to gather information on other topics. Some information may not be available in certain settings. In sum, each question or piece of information should be assessed in terms of its relevance to the study, the feasibility of collecting it accurately, and its reliability.

Finally, it is extremely important that the exam­ples and methods in this manual not be used to support perceptions and realities of the RAP user but rather those of the participants and communities concerned, i.e., those participating in the study; members of the target audience. The data provided to the data collectors should be reported verbatim, with data collectors’ perspectives and comments on what is being observed and relayed during an interview or focus group off-set to distinguish the data collectors’ comments from actual data to be analyzed. At the end of the data collection process, it is impor­tant to take information such as domains and cultural insider (ethno-) classifications back to the target audience/population of interest for discussion and confirmation. The data analysis section of the Food & Fitness RAP manual (see Chapter 8) contains some suggestions for doing this, and focus groups may also be used for this purpose.

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