Background: Efficacious pediatric weight management (PWM) programs have existed for over two decades, but there is limited evidence that these programs have been translated into regular practice. There is even less evidence that they have reached communities experiencing health disparities where access to care is limited. The purpose of this project was to use a community-engaged approach to select an evidence-based PWM program that could be delivered with the available resources in a community that is experiencing health disparities. Methods: The project was developed by the Partnership for Obesity Planning and Sustainability Community Advisory Board (POPS-CAB) in the Dan River Region of southwest Virginia. The POPS-CAB included representatives from a local pediatric health care center, the Danville/Pittsylvania Health Department, Danville Parks and Recreation, the Boys and Girls Club, and the Fralin Center for Translational Obesity Research (n=15). Three PWM programs were identified that met the criteria of demonstrating short and longer-term efficacy, across multiple studies and diverse populations, in reducing childhood obesity for children between the ages of 8 to 12 years across multiple studies. The programs included the Traffic Light Diet, Bright Bodies, and Golan and colleagues' Home Environmental Change Model. All three programs included a high frequency of in-person sessions delivered over a 6-month period, but one included an adapted version that delivered the content via interactive technology and could be delivered with far fewer resources (Family Connections adapted from the Home Environmental Change Model). A mixed-methods approach was used to determine program selection. This approach included individual POPS-CAB member rating of each program, followed by small group discussions, a collective quantitative rating, and, once all programs were reviewed a rank ordering of programs across characteristics. Finally, a large group discussion was conducted to come to agreement on the selection of one program for future local adaptation and implementation. All small and large group discussions were audio recorded and transcribed verbatim to identify themes that influenced the program selection decision. The quantitative results were averaged across individuals and across the groups. Qualitative results were reduced to meaning units, and then grouped into categories, and lastly, themes. Results: Individual ratings across Bright Bodies, Family Connections, and Traffic Light were 3.9 (0.3), 3.6 (0.5), and 3.4 (0.4), respectively. The ratings differed slightly between community and academic partners demonstrated by a higher rating for Bright Bodies by community members and a higher rating for Family Connections by academic members. After small group discussions the average group ratings across the programs was 3.8 (0.4) for Bright Bodies, 3.5 (0.6) for Family Connections, and 3.4 (0.6) for Traffic Light. Finally, the rank order of programs for potential implementation was Bright Bodies, Family Connections, and Traffic Light. Qualitative information for each program was broken down into four main themes of discussion, (1) the importance for the chosen program to have a balance of nutrition and physical activity, (2) negative perceptions of calorie counting, (3) a desire to target both the parent and the child, as well as (4) the need for practicality and usability the target settings. During the final large group discussion, the above themes suggest that the primary reasons that Bright Bodies was selected included the availability of nutrition information, structured physical activity sessions, presence of a usable workbook, as well as the balance of parent and child involvement. Conclusion: Key considerations in program selection were related more to the program content, delivery channel, and available resources for replication rather than simply selecting a program that was less resource intensive. / Master of Science

abstract: Despite widespread acknowledgement of the need for transformation towards sustainability, the majority of cities appear stuck in incremental change instead of far-reaching, radical change. While there are numerous obstacles to transformational change, one critical aspect is the process of selecting impactful sustainability programs. The unique and complex nature of sustainability suggests a different approach is needed to program selection than is normal. But, to what extent are cities adapting selection processes in response to sustainability and what effect does this have on sustainable urban transformation? Could there be a more effective process to select programs with greater transformational potential? This dissertation investigates these questions using case studies and action research to add to the general knowledge of urban sustainability program selection and to develop practical knowledge (solutions) for more effective sustainable urban transformation. The dissertation consists of three studies. Study 1 uses a case study approach to investigate existing sustainability program selection processes in three cities: Avondale, USA; Almere, the Netherlands; and Freiburg, Germany. These cities all express commitment to sustainability but have varying degrees of sustainable development experience, accomplishment, and recognition. Study 2 develops a program selection framework for urban sustainable transformation drawing extensively from the literature on sustainability assessment and related fields, and on participatory input from municipal practitioners in Avondale and Almere. Study 3 assesses the usefulness of the framework in a dual pilot study. Participatory workshops were conducted in which the framework was applied to real-world situations: (i) with the city’s sustainability working group in Avondale; and (ii) with a local energy cooperative in Almere. Overall, findings suggest cities are not significantly adapting program selection processes in response to the challenges of sustainability. Processes are often haphazard, opportunistic, driven elite actors, and weakly aligned with sustainability principles and goals, which results in selected programs being more incremental than transformational. The proposed framework appears effective at opening up the range of program options considered, stimulating constructive deliberation among participants, and promoting higher order learning. The framework has potential for nudging program selection towards transformational outcomes and more deeply embedding sustainability within institutional culture. / Dissertation/Thesis / Doctoral Dissertation Sustainability 2015