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Table 1 Logic of change: selected examples of performance and change objectives

From: Health Equilibrium Initiative: a public health intervention to narrow the health gap and promote a healthy weight in Swedish children

Children

Performance objectives

Change objectives

Strategies

Increase numbers of children that commute actively

1 the norm is to walk or bike to school

Establish the norm by information, highlighting alternatives and affecting environmental outcomes (traffic situation, lighting)

Evaluation: Meeting reports, interviews

Evaluation: numbers of children commuting actively to school

2 children know that active commuting is healthier and better for the environment

Talk to children about their health and how it is affected by various variables, including physical activity.

Evaluation: Quantitative study

3 children believe that they can walk or bike to school

Support the children in removing barriers

Evaluation: Meeting reports, interviews

4 children believe that they as a group can start active commuting

Discuss the matter at group level. Encourage the feeling of doing this together.

Evaluation: Meeting reports, interviews

Increase numbers of children that have breakfast daily

1 the norm is to have breakfast

Establish the norm by information and highlighting of alternatives. Focus on parental responsibility

Evaluation: Meeting reports, interviews

Evaluation: Quantitative study

2 children know that breakfast makes them feel better and that it is good for school performance

Offering healthy breakfast at school. Making it seem simple to eat at home. Engaging children in the development of menus.

Evaluation: Meeting reports, interviews

3 children believe that they can go to school earlier to have breakfast, or get something at home

Discussing possibilities and barriers, including bedtime

Evaluation: Meeting reports, interviews

6 older children can prepare in the evening.

 

Parents

Performance objectives (behavioural)

Change objectives

Strategies

Increase numbers of children that have breakfast daily

2 parents believe that having breakfast is important for their children

Confirming and conveying knowledge, discussion of alternatives

Evaluation: Meeting reports, interviews

Evaluation: Quantitative study

3 parents believe that they can offer their children a healthy breakfast

Confirming the variety possible within the concept healthy breakfast, and the parental competence

Evaluation: Meeting reports, interviews

6 parents facilitate their children’s breakfast eating by buying and serving food, helping with sleep habits

Confirming and conveying knowledge, discussion of alternatives

Evaluation: Meeting reports, interviews

Environment

Performance objectives

Change objectives

Strategies

Increase numbers of children that have breakfast daily

1 school supports the norm of having breakfast, without casting blame or stigmatization

Serving breakfast, discussing the matter at health lessons, practical education including cooking breakfast

Evaluation: Meeting minutes, interviews

Evaluation: Quan study

2 school conveys and confirms knowledge about the health aspects of breakfast

Evaluation: Curriculum, meeting reports, interviews

Integrated in curriculum, and implemented

3 school implements strategies for enhancing self-efficacy in health education

Integrated in curriculum, and implemented

Evaluation: Curriculum, meeting reports, interviews

4 school serves breakfast

Integrated in curriculum, and implemented

 

Evaluation: Document whether the school serves breakfast, and how many children attend

 
  1. Performance objectives are chosen to support the overarching aim of the intervention. They answer questions like “What do the children/parents need to do to perform the health-related behavior?” (behavioral level) and “ What does someone in the environment need to do to accomplish the environmental outcome?” (environmental level).
  2. Determinants for change objectives are affected through specific strategies, based on Social Cognitive Theory. Numbers refer to specific determinants (listed below the table).
  3. Performance objectives are theoretically informed and developed in discussions with residents and local professionals. The lists will develop during the interventions.
  4. Determinants
  5. 1. Reciprocal determination.
  6. 2. Outcome expectations.
  7. 3. Self-efficacy.
  8. 4. Collective efficacy.
  9. 5. Observational learning.
  10. 6. Facilitation.