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An evaluation of European Youth Tackling Obesity (EYTO);

A youth led social marketing campaign to encourage healthy lifestyles

1.0 Background Launched in September 2013, EYTO is developing an innovative peer-led social marketing campaign to promote healthy eating and physical activity and stem the rise in obesity among young people. Over the course of two years, NCB will lead a partnership with organisations in Spain, Portugal and the Czech Republic. Together they will:

• conduct a review of effective social marketing and healthy lifestyle interventions; • recruit groups of disadvantaged young people to lead the development of the

campaign; • support the young people to research, create and pilot the campaign; provide

opportunities to meet up; and • develop a website to promote the campaign across Europe.

1.1 Evaluation aim and objectives The NCB Research Centre will lead the evaluation of the EYTO project. Over the course of the two year project, the evaluation will provide a formative and summative assessment of its progress and effects. The overall aims of the evaluation are to:

• provide an initial evaluation of the project start up and progress achieved towards its objectives in the first year;

• gather feedback from campaign creators, campaign participants, stakeholders and partners to explore if and how the project meets its objectives, and what process and impact outcomes are achieved.

The objectives are to evaluate the impact of the campaign against the expected process and outcome indicators1. We will focus on the project’s achievement of the outcome indicators for young people, which are as follows:

• Young people and practitioners across the four partnerships have increased skills and confidence in applying participatory social marketing techniques.

1 These are detailed in full in the Grant Application Annex 1a 19th April (2) pdf.

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• At least 80 per cent of young people who engage in the campaign report increased motivation to eat more healthily and be more physically active.

• At least 60 per cent of young people engaging with the campaign report increased levels of physical activity and fruit and vegetable consumption.

The evaluation will assess of the extent to which the local dimension of the fourth outcome indicator is achieved;

• Partners, policy makers and planners at a local, national and European level have increased understanding of successful social marketing approaches to tackle obesity amongst disadvantaged young people.

NCB’s Health and Social Care team will gather evidence of the extent to which the project improves understanding amongst national and European level stakeholders by seeking feedback from colleagues by introducing a short on-line survey on the final campaign website. The fifth and final project outcome indicator will be monitored by NCB’s Health and Social Care team as part of wider project work, as it is beyond the scope of this evaluation;

• There is evidence of increased sharing and replication of good practice amongst EU Member States participating in the project.

2.0 Methodology

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2.1 Focus groups with campaign creators Focus groups with campaign creators will be carried out at the start of the project (baseline), at the end of phase one (process), and at the end of the project (impact).

At this stage we expect to collect evidence around the following broad topics, although these and the specific issues covered around each broad topic may be revised as the project develops:

• motivation to participate and what they hope to get out of taking part personally and for other young people;

• views on the causes of obesity in their areas and what could help to reduce it; • views on the barriers/enablers to healthy lifestyles; • perceptions of their skills, confidence and knowledge of participatory social

marketing campaigns; • perceptions on the impact of the campaign on young people; • perceptions of impact on themselves; • views on what else is needed to make a permanent change in obesity rates in their

areas; • plans for the future.

2.2 Open online survey of campaign participants An open online survey will be designed to capture the project’s effects on campaign participants with predominantly closed questions linked to the project’s objectives. Based on previous NCB experience of running surveys, we expect about 30-35% response to the survey and hope to gather data from 200 - 400 campaign participants overall (NB: obviously this depends on how many people access the campaign).

At this stage we expect to collect evidence around the following broad topics, although these and the specific issues covered around each broad topic may be revised as the project develops:

• perceptions of the campaign; • awareness and motivation to find out more; • views on the causes of obesity in their areas and what could help to reduce it; • views on the barriers/enablers to healthy lifestyles; and • intention to change to eat more healthily, do more physical activity (linked to

outcomes).

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2.3 Stakeholder telephone interviews The views of stakeholders will be sought via telephone interviews towards the end of the project. A maximum of five telephone interviews will be carried out in each country; 20 in total. Interviewees are likely to include representatives from local youth, community, and health services in the areas where the campaign is targeted.

The telephone interviews will cover much of what will be covered in the focus groups with campaign creators but will be tailored for adults

• views on the causes of obesity in their areas and what could help to reduce it; • views on the barriers/enablers to healthy lifestyles; • perceptions on the impact of the campaign on young people; • perceptions of impact on themselves; • views on what else is needed to make a permanent change in obesity rates in their

areas; and • potential wider changes to policy and practice as a result of the campaign.

2.4 Focus group with partners The views of partners will be explored at the project partnership meeting in London mid-way through the project to evaluate the success of processes established to support the delivery of the project. During the focus group partners will be asked to reflect on:

• progress towards achieving the outcome indicators, including if and how they, policy makers and planners have increased their understanding of social marketing approaches to tackling obesity among disadvantaged young people;

• what is working well and less well; and • what, if anything needs to change to inform the continuous development of the

project.

2.5 How the qualitative data will be collected and analysed As explained in section 3 on project management, NCB Research Centre will have responsibility for designing the qualitative elements, for coordinating the qualitative fieldwork and analysis, and for reporting the qualitative findings (as well as integrating them with the results from the quantitative data from the open survey).

Topic guides will be developed for focus groups with young people, the interviews with stakeholders and for the focus group with partners to ensure that the evaluation objectives are covered consistently, while allowing for flexible responses to individual circumstances. Appropriate facilitative techniques will be developed for the groups to ensure all participants are able to contribute and express their views.

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All researchers involved in the fieldwork will be briefed by the project manager. With respondents’ permission, focus groups and interviews will be digitally recorded and transcribed verbatim.

The interviews and focus groups will be analysed using Framework, a rigorous and systematic method that allows in-depth thematic and within case analysis. Initial broad themes linked to the evaluation questions will provide a starting point for the analysis. As further themes emerge, the index of key themes will be revised and refined. A matrix is drawn up for each theme, with the columns representing key sub themes and the rows representing each group/interviewee. Data from each transcript is summarised in the appropriate cell. The final matrices provide a full picture of each group/individual’s views, display the range of views described by participants and allowed the accounts of different participants and groups of participants to be compared.

2.6 How the quantitative data will be collected and analysed The Health and Social Care Team will provide the sample for the open survey of campaign participants and will create a single website to host the survey. The survey will be designed and administered centrally by the NCB Research Centre, with the support and consent of partners. We will work with partners to develop the survey, using validated tools to assess the impact of the campaign on levels of physical activity and fruit and vegetable consumption where possible and appropriate.

The survey will be accessible in the languages of the four participating countries to support survey coordination, data collection, cleaning and analysis.

The short online survey will be designed using Snap software; this will take no more than 10-15 minutes to complete. Survey questions and items will primarily be close-ended (i.e. multiple choice, tick boxes or rating scales) with selected open-ended questions for topics that are more exploratory. The data will then be extracted and analysed using PASW Statistics 18.

3.0 Project direction and management The NCB Research Centre will carry out the following activities:

• Devise an evaluation plan to outline the purpose of the evaluation against objectives, indicators and outcomes, the proposed evaluation design and methodology, how the project will be monitored against key milestones, and the tasks and responsibilities of all partners contributing to the evaluation (this document).

• Design topic guides (so that partners may work with evaluators in their countries to carry out baseline and follow up focus groups) and analysis frameworks, to enable partner countries to analyse their findings and feedback results to the Research Centre for collation.

• Conduct focus groups with campaign creators in England

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• Conduct interviews with other relevant stakeholders in England • Design, carry out and analyse the results of online surveys with campaign

participants (all countries) • Design systems to record campaign activities – i.e. number of events and numbers

attending, numbers of hits of campaign websites, number of resources downloaded etc (that can be used in all four countries)

• Produce an interim and final evaluation report including key findings and recommendations.

3.1 Evaluation input from partner organisations Each country has 20 days allocated for evaluation activities. Broadly, in line with the days allocated to the NCB Research Centre for core evaluation activities we suggest that partner countries allocate the following number of days to each task over the 2 years, as shown in Table 1.

Table 1: Proposed allocation of evaluation days by partner countries

Task Proposed number of days

Familiarisation/preparation 1 3 x focus groups with campaign creators 3 Focus group charting (analysis) 2 Setting up stakeholder interviews 1 5 x stakeholder interviews (including write up) 2-3 Reporting on individual country’s qualitative data 4 Translation of open survey 1 Promotion in country 1 Management 2

3.2 Options to extend the scope of the evaluation The evaluation methodology devised by NCB’s Research Centre represents a sound approach to evaluating the project within the confines of available resources. Partners may want to extend the scope of the evaluation if there is a desire to collect more scientific data about the impact of the campaigns. Partners have the option to invest their time and resource into additional evaluation activities (i.e. recruiting a control group of young people/securing approval from Ethics Committee) so long as they complete the tasks set by NCB and provide the specific range of data agreed for the main evaluation in the specific comparable and consistent formats agreed with the central team

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3.3 Suggested person specification for partner evaluators Here we set out the skills and experience researchers/evaluators in partner countries will need to evaluate the project in their country and what they will be responsible for.

Skills and experience

• A graduate qualification in a relevant social science, and experience of social research outside study for academic qualifications and which has involved children and young people.

• Good understanding of the requirements of high quality research, able to apply those requirements to own research practice and to appraise the quality of research conducted by others.

• Good understanding of principles of research project management, experience of managing small scale research projects or elements within larger projects.

• Good understanding and experience of different qualitative and quantitative sampling and data collection approaches and able, with guidance, to design appropriate samples and data collection tools.

• Able to analyse and interpret quantitative and qualitative data. • Experience of communicating research findings to different audiences, including

proven ability to write clearly and concisely using a logical structure and to present research findings orally.

• Understanding of ethical and data protection issues in research and ability to apply these to their own work.

• Good computer literacy including word processing, survey and data analysis packages, database management and excel.

4.0 Evaluation outputs At the interim and final stages of the project, we will draw together the evidence from the focus groups, stakeholder interviews and open survey of campaign participants. The accessible reports aimed at partners and funders will provide an analysis of the projects achievements.

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4.1 Evaluation timetable Year 1 September – December 2013

• Scoping evaluation

w/c 24th March 2014

• Draft topic guide for focus groups circulated by NCB to partners for comments

w/c 7th April 2014

• Final topic guide agreed • Analysis framework disseminated to partners by NCB

April-May 2014 • Each partner conducts baseline focus groups with 5 ‘campaign creators’

• Tool for recording campaign activities circulated to partners by NCB

w/c 2nd June

• Partners to submit focus group data to NCB for collation

July 2014

• Draft on-line survey circulated to partners for comment by NCB

August-September 2014

• On-line survey is agreed, translated and set-up by each partner

September – October 2014

• Focus group with partners (led by NCB’s Research Centre and to take place at the meeting in London)

September- October 2014

• Post phase 1 focus group with 5 campaign creators (led by NCB’s Research Centre and to take place at the meeting in London)

October 2014

• Online survey is launched by each partner (aiming for 50 – 100 campaign participants in each country)

Year 2 January 2015 • Interim report (to be written by NCB Research Centre) February 2015 • Topic guides and analysis frameworks finalised and

circulated by NCB April-May 2015

• Each partner conducts telephone interviews with 5 stakeholders in each country

• Each partner conducts post phase 2 focus group with 5 campaign creators in each country

End of June 2015

• Data from telephone interviews and focus groups submitted by partners to NCB for collation and analysis

July 2015 • On-line survey is launched by each partner (aiming for 50 – 100 campaign participants in each country)

September 2015 • Final evaluation report produced by NCB

EYTO: Evaluation report E. Amalathas and K. Rix

European Youth Tackling Obesity

End of project evaluation

Evangeline Amalathas and Katie Rix

National Children’s Bureau: working with children, for children

Registered Charity Number 258825. 8 Wakley Street, London EC1V 7QE. Tel: 020 7843 6000

Connect with us: Facebook: www.facebook.com/ncbfb Twitter: @ncbtweets

© NCB, September 2015

http://www.facebook.com/ncbfb


www.ncb.org.uk page 2 © National Children’s Bureau September 2015

Contents

Acknowledgements ............................................................................... 3

Executive Summary .............................................................................. 4

Background .............................................................................................. 4

Evaluation ................................................................................................ 4

Findings ................................................................................................... 5

1. Introduction .................................................................................... 13

1.1 Background ..................................................................................... 13

1.2 Evaluation of EYTO: Aims and methodology ............................................ 14

1.3 Report structure .................................................................................. 15

2. Findings: Impact of activities ............................................................. 16

2.1 Activities ............................................................................................ 16

2.2 Number of individuals engaged in activities ............................................ 18

2.3 Duration of event activities ................................................................... 19

2.4 Target audiences ................................................................................. 20

2.5 Section overview ................................................................................. 21

3. Findings: Campaign Creators Focus Groups ......................................... 23

3.1 Highlights from the interim report: Campaign Creators ............................ 23

3.2 Final evaluation focus group with Campaign Creators .............................. 24

3.4 Social marketing ................................................................................. 27

3.5 Findings from self-assessment tasks: Impact on Campaign Creators ......... 29

3.6 Impact on peers and other audiences .................................................... 40

3.7 Key findings from each country ............................................................. 42

3.8 Suggestions for practitioners and policymakers ....................................... 46


4. Findings: Survey with children and young people and other audiences .... 50

4.1 Introduction to survey ......................................................................... 50

4.3 Respondents engagement with activities ................................................ 52


5. Findings: Stakeholders ..................................................................... 67

5.1 Highlights from the interim report: EYTO management teams ................... 67

5.2 Obesity: Populations most at risk .......................................................... 69

5.3 Causes of obesity ................................................................................ 70

5.4 EYTO Campaign .................................................................................. 73

5.5 Social media ....................................................................................... 78

5.6 Impact ............................................................................................... 81

5.7 Suggestions for practitioners and policymakers ....................................... 84


6. Conclusions and recommendations ..................................................... 93

6.1 Conclusions ........................................................................................ 93

6.2 Recommendations ............................................................................... 95

http://www.ncb.org.uk/



Acknowledgements

We would like to thank the following people for their contribution to this

evaluation:

From Czech Republic: Dagmar Skupová and her colleagues at

Komunikujeme. From Portugal: Fabiana Gomes and her colleagues at Companhia de

Ideias.

From Spain: Ignasi Papell and his colleagues at CTNS Technology Centre of Nutrition and Health.

From UK: Amy Davies at National Children’s Bureau (NCB), Health and Social Care team.

Thank you also to our NCB Research Centre colleagues who contributed to the earlier waves and reports of this evaluation including Puja Joshi, Vanessa

Greene, Joanna Lea, and Eliza Buckley. Thank you also to Amy Edwards for her support with this report.




Executive Summary

Background

European Youth Tackling Obesity (EYTO) was a youth-led and peer-to-peer project that used social marketing campaigns to tackle obesity among children

and young people. It was particularly targeted at children and young people aged 13 to 18 living in disadvantaged communities, who are likely to make more choices by themselves as they make their transition to adulthood. The

project was funded by European Union Executive Agency for Health and Consumers in the framework of the Health Programme 2008-2013.

This European project was led by National Children Bureau’s (NCB) Health and Social Care team in the UK, and delivered in partnership with four other

organisations in Spain, Portugal and the Czech Republic. There were three main project objectives, which are set out below:

Young people and practitioners across the four partnerships will have increased skills and confidence in applying participatory social marketing

techniques. At least 80 per cent of young people who engage in campaigns will have

increased their motivation to eat more healthily and be more physically active.

At least 60 per cent of young people who engage in campaigns will have

increased their levels of physical activity and fruit and vegetable consumption.

Although each campaign was tailored for audiences in their own countries, all the campaigns had the following in common:

They were youth-led, placed young people at the centre of the project, and supported them to plan, develop and deliver activities.

They used peer-to-peer approaches so that the campaigns were designed by young people for young people. This helped to ensure activities and

information were accessible and appealing for peers. They used a particular social marketing approach: eight benchmark criteria

of social marketing1, which was a combination of online and face-to-face

interactions – that aimed to influence and change behaviours of audiences.

1 Andreasen, A. (2002) Marketing Social Marketing in the Social Change

Marketplace. Journal of Public Policy & Marketing Vol. 21 (1) p. 3–13




Evaluation Following on from the interim evaluation report (February 2015) which included

findings at baseline and interim stages of the evaluation, this is the final evaluation stage of the EYTO project led by the NCB Research Centre.

It evaluates activities against initial project objectives outlined above and identifies the project impact. This involved:

To identify the impact of the project, data was gathered and reported at the baseline (in August 2014), interim (in January 2015) and final (in July 2015)

stages of evaluation. This included a combination of quantitative and qualitative methods to gather and analyse data on the impact of the campaigns. The

following was reported at interim and final stages, with the exception of talking with Campaign Creators which was undertaken at all three stages of evaluation:

Talking with the Campaign Creators, young people who delivered the

campaigns. Talking with professional stakeholders (e.g. EYTO management teams,

youth workers, local and national policymakers) Analysis of all the activities and information that were delivered during the

campaigns. This was recorded by Campaign Creators and EYTO

management teams using impact spreadsheets. Analysis of an online survey completed by peers and other audiences who

had engaged with the campaigns2.

Findings

Impact of activities

The evaluation included an analysis of the impact of the activities that were run with young people, based on information recorded and reported by Campaign

Creators and EYTO management teams using impact spreadsheet. Findings showed that:

The most common type of activity was face-to-face events, followed by website-based and paper-based activities.

The duration of events ranged from one to 35 hours, and included lectures, workshops and exhibitions.

The most reported web-based activity by all four countries was Facebook.

A greater number of events were delivered by all partners than paper-based activities.

A total number of 9,503 individuals engaged with paper-based activities. This ranged from 350 (Portugal) to 8,175 (UK).

A total number of 4,336 individuals engaged with events activities. This ranged from 250 (UK) to 3070 (Spain).

A total number of 2,984 individuals engaged with web-based activities.

This ranged from 181 (UK) to 1370 (Portugal).

2 This online survey was launched in November 2014 and continued until July 2015.




The most reported audience group that activities were targeted at was children and young people.

Campaign Creators

Campaign Creators (the young people who were involved in the campaign delivery) participated in focus groups in their respective countries at baseline, interim and final stages of evaluation. These were used to gather information

about their experiences of working on the campaigns, opinions on issues regarding obesity, skills they had improved as a result of the campaigns, and

suggestions for taking forward findings from the campaigns. A summary of key findings collated at baseline and interim stages (presented in

the interim report) is followed by key findings from the focus groups undertaken during wave 3, the final evaluation.

Summary of key findings collated at baseline and interim stages of evaluation

Campaign Creators expectations of working on the campaigns were:

A desire to become healthier and motivate others to do so.

Create something interesting to share with friends/school peers Meet new people and learn new skills

Campaign Creators reported improvements in skills and confidence for using social marketing methods.

The interim evaluation suggested recommendations were for Campaign Creators to receive support with improved understanding of social marketing

approaches and how it can be applied within the wider context of health campaign, and how to influence behaviours

Summary of key findings collated at final stage of evaluation

Activities

Campaign Creators enjoyed a range of activities, including organisation

and delivery of events and communication of information. They also identified activities that they did not enjoy and suggested support in further areas such as website development.

Campaign Creators reported that they received support from the EYTO management team, but approaches and intensity of support varied

between countries.

Challenges

A key challenge for all Campaign Creators related to having limited time to

work on the project, as they had to balance their EYTO project commitments with busy schedules of attending classes, preparing for

exams, and home and social activities.




Social marketing

Social marketing was an effective approach for connecting and cascading

information and messages directly to their own networks and people that they would not normally meet.

The most effective messages to communicate were positive and inspirational ones that promoted the benefits of healthy lifestyles. These were considered more likely to motivate individuals to make positive

changes in their behaviours. Negative habits and behaviours of families and peers were considered to

be counter-productive to social marketing that encouraged healthy lifestyles.

Social marketing provides information, but the decision to take up advice

and information that lead to healthy behaviours is the responsibility of each individual.

Impact on Campaign Creators

Campaign Creators undertook a range of activities during the campaigns, and they were asked about their prior experience. When asked about their

interest in the activities - 160 (85.6%) of the total number of responses showed that they had yes a lot of interest in the particular areas of work

compared to 21 (11.6%) and 6 (3.2%) who stated yes a bit and no, respectively. The areas of work that they had the most interest in were:

worked with people from other countries; organised or helped run an event; carried out a project with people you have never met before; and given a presentation to lots of people.

Campaign Creators rated their confidence when using seven particular skills - 106 (85%) of the total number of responses were either very

confident or confident compared to 18 (14%) and 1 (0.8%) who indicated neither confident or unconfident and unconfident, respectively. The areas of work that they felt very confident about applying skills were: cultural

awareness; using information; and communication. Campaign Creators were asked about whether they had developed skills

and confidence in ten key areas and their responses were compared with ones recorded at baseline, interim periods of the campaigns. They self-reported an overall improvement in skills and confidence over the course

of the campaigns. Of the total number of responses - those who had reported no development in skills and confidence had fallen from 28

(12.1%) at baseline to 14 (9.2%) at (wave 3), and those who reported yes a lot had risen from 104 (45%) at baseline to 136 (72.7%) at wave 3.

There were improvements reported in the following skills:

communications; cultural awareness; collaboration; using information; and project management.

Impact on peers and other audiences

Campaign Creators rated the project impact on their audiences using a Likert scale ranging from 1 (not at all successful) to 10 (very successful).

Findings showed that campaigns had the most impact, i.e. rated 8, 9 or 10, with providing information and increasing awareness (11participants).

This was followed by changing attitudes (13) and motivating young people (7).




Limited impact recording and reporting

There appeared to be limited recording and reporting of impact by

Campaign Creators which made it challenging to capture impact on audiences, in particular what and how behaviours have been changed as a

result of the campaigns, and which groups have benefited the most from the campaigns.

Survey with children and young people and other audiences who engaged with the campaigns

A survey was conducted with young people in each of the four countries. There were 237 respondents. This survey aimed to find out how audiences had

engaged with the campaigns, and their attitudes and behaviours regarding healthy eating and physical activities. The main findings are shown below.

Activities

Of the 197 respondents who stated that they had engaged with at least one campaign activities, the most indicated response was Facebook

(40.8%). Answers suggest that web-based activities (Facebook, online

video/youtube, Instagram, Twitter) were the most effective approach for engagement as these had combined responses of 232 (60%), when compared with events and paper–based activities.

Impact on behaviours

Of the 237 respondents, 213 (89.9%) rated campaigns as either

somewhat effective or very effective in encouraging them to eat a more healthy diet and be more physically active.

Respondents were also asked to rate the campaigns’ effectiveness on

whether it had engaged, communicated, motivated and demonstrated for audiences to eat a more healthy diet and be more physically active. Across

the 237 respondents who answered these questions there were 1,185 responses – of which 605 (51.1%) indicated somewhat effective and 444

(37.5%) indicated very effective.

Current behaviours and attitudes

Most respondents (165, 69.6%), wanted to make changes to their diet and

exercise routine - of which 113 (47.7%) felt that they were already leading a healthy lifestyle and 52 (21.9%) described their lifestyle as being

unhealthy. In regards to taking forward learning from the campaigns – most

respondents indicated that they thought, talked and shared information

about the campaigns. For example across the 216 respondents, there were 402 responses – of which 99 (24.6%) respondents thought about eating a

healthy diet and being physically active. This was followed by 97 (24.1%) who talked about the campaign with a friend/parent 41 (10.2%) and 72 (17.9%) who shared the link about the campaign or information about the

campaign with a parent/friend. In comparison fewer respondents indicated taking actions as a result of the campaigns, for example 42 (10.4%)




stated that they made a change to eat a more healthy diet and be more physically active.

Causes of obesity

Factors mentioned include 130 (24.1%) respondents who indicated eating

too much unhealthy food. This was followed by not doing enough physical activity as indicated by 115 (21.3%).

Further analysis of responses showed that behaviours associated with

eating and physical activity were considered to be the main causes of obesity – 262 (48.6%) of responses were associated with eating i.e.

consuming too much food, unhealthy foods or not eating healthy foods, and 178(33%) of responses were associated with not taking enough physical activities.

Factors that help young people to make healthy choices and live healthy lives

The most important factors mentioned indicated by 101 (19.4%) respondents was support from their parents/carers to get healthy. This was followed by access to opportunities for sports and other physical

activities and enjoying physical activity indicated by 70 (13.4%) and 61 (11.8%) of respondents, respectively.

Further analysis of the responses showed that 194 (37.2%) responses were associated with support, in particular support from personal and

social networks. The enjoyment of activities and healthy foods was indicated by 108 (20.5%) respondents, and 100 (19.2%) respondents referred to access to opportunities and resources.

Factors that deter young people from making healthy choices and live

healthy lives

The most important factor as indicated by 69 (16.9%) responses was being with friends who eat unhealthily. This was followed by not enough healthy meals available in schools and lack of discipline indicated by 52

(12.7%) and 51 (12.5%) respondents, respectively. Further analysis of responses showed that 233 (42.8%) responses were

associated with motivation for making changes and adopting new behaviours. Knowledge and understanding of how to lead a healthier life, such as not knowing how to cook and not knowing enough about calories,

were considered to be of value, but only 28 (5.1%) thought they were important factors.

Stakeholders

Interviews were undertaken with stakeholders (e.g. local and national

policymakers, youth workers) to explore their views on obesity, the campaigns, social marketing and suggestions for taking forward learnings from the

campaigns. A summary of key findings collated at baseline and interim stages (presented in

the interim report) is followed by key findings from interviews undertaken with stakeholders during wave 3, the final evaluation.




Summary of key findings collated at baseline and interim stages of evaluation

EYTO management teams took part in a focus group in October 2014 and

suggested the following overarching objectives across all four countries: Raise awareness of obesity among children and young people Build evidence

Change behaviours.

EYTO management teams identified early outcomes of the campaigns, including how to use social media to communicate serious messages and not only for exchanging messages with friends about social matters –and the

limitations of doing so.

EYTO management teams discussed and suggested approaches for how to use social marketing as a tool for health development work.

EYTO management teams explored and suggested approaches for how to support youth-led social marketing work.

Summary of key findings collated at final stage of evaluation

Obesity and its causes

According to stakeholders, causes of obesity are multi-dimensional and require a joined-up and collaborative approach between professionals in

different sectors and parents at home. A few examples of these include poverty, modern day lifestyle habits, and emotional wellbeing.

The type of risk experienced by children and young people were thought to be different from adults as parents had greater influence over children and young people’s opportunities to make choices, access to resources, and

attitudes to foods and physical activities. Thus their experiences could be better understood within the context of the family model.

The campaigns were particularly targeted at children and young people aged 13 to 18, as they were becoming more independent and making choices by themselves and thus required support with making healthy

choices.

EYTO campaigns

Stakeholders reported that campaigns added-value to existing initiatives that promoted health and wellbeing in each of the four countries.

The youth-led and peer-to-peer approach was unique and brought many

benefits to the way information and activities were developed and delivered, and the way in which peers had engaged with the campaigns.

The challenges faced by Campaign Creators included the limited time frame to plan and deliver activities, and no or limited follow-up activities that audiences can access after their engagement with campaign activities.

Social media




Stakeholders said that social media could be an effective way of communicating with children and young people, but only if it is used with a

specific purpose in mind and with appropriate content. Social media was ideal for initial engagement and evoking audience’s

curiosity, and as a channel for positive exchange of ideas and for interaction. However, social media was not considered to be a replacement for face-to-face interactions.

Impact

Stakeholders reported that Campaign Creators developed knowledge and a

range of skills that enabled them to plan and deliver activities and information for their audiences.

Children and young people’s choices for making behaviours changes were

shaped by factors such as parental influence. This is linked to earlier point about the type of risk was seen to be different from adults and their

experiences had to be understood within the context of the family model. Stakeholders reported that it was too early to see the impact of the EYTO

project on changes in practice, but campaigns had the potential of adding

value to existing programmes and policies that support healthy lifestyles and tackle obesity among children and young people.

Conclusions

EYTO campaigns worked towards initial objectives of increased understanding

and motivation for healthy eating and undertaking physical activities.

Key aspects of the campaigns that made it effective in engaging with and supporting children and young people on the topic of obesity were:

A youth-led and peer-to-peer approach that placed young people at

the centre of the campaigns and gave them greater control over the

provision of reliable, relevant and accessible information. Capabilities development of Campaign Creators so that they were

better prepared to make decisions and lead on activities. Raised awareness of obesity and increased motivation to address

unhealthy lifestyles among children and young people and a range of

stakeholders. Provided experiences or encouraged audiences to experience changes

that are different from their daily habits.

However, the use of campaigns alone may not bring about changes in behaviours, in particular long-term sustainable changes. These changes require

increased collaborative working with parents and professionals in the community and from different sectors to ensure children and young people have

accessible and available options to make healthy choices.

Recommendations

Findings from the focus group with the Campaign Creators, interviews with stakeholders, and survey with children and young people and other audiences

who engaged with the campaigns – all have helped to identify recommendations for practitioners and policymakers. These aim to develop




holistic and collaborative approaches for tackling obesity among children and young people, and are as follows:

Positive and inspirational key messages

Provision of relevant and reliable information Provision of accessible options for healthy choices Effective targeting of vulnerable groups

Youth-led and peer-to-to peer approach Holistic and collaborative approach

Family model approach: Capacity building of parents Robust and standardised recording tools




1. Introduction

1.1 Background

European Youth Tackling Obesity (EYTO) was a youth-led and peer-to-peer project that used social marketing campaigns to tackle obesity among children

and young people. It was particularly targeted at children and young people aged 13 to 18 living in disadvantaged communities, who are likely to make more choices by themselves as they make their transition to adulthood. The

project funded by European Union Executive Agency for Health and Consumers in the framework of the Health Programme 2008-2013.

This European project was led by National Children Bureau’s (NCB) Health and Social Care team in the UK, and delivered in partnership with four other

organisations in Spain, Portugal and the Czech Republic. Although each campaign was tailored for audiences in their own countries, all the campaigns

had the following in common:

They were youth-led, placed young people at the centre of the project, and

supported them to plan, develop and deliver activities. They used peer-to-peer approach so that campaigns were designed by

young people for young people. This helped to ensure activities and information were accessible and appealing for peers.

They used a particular social marketing approach: eight benchmark criteria

of social marketing3, which was a combination of online and face-to-face interactions that aimed to influence and change behaviours of audiences.

The organisations involved in each country along with the names and website links to the campaigns are presented in Table 1, below.

Table 1: EYTO management teams and campaigns

Country EYTO management

team

Campaign name and website link

Czech

Republic

Komunikujeme Nebud’ Pecka

www.facebook.com/Eytocz

Portugal Companhia de Ideias Luta por ti

www.facebook.com/EytoPortugal

Spain CTNS Technology Centre

of Nutrition and Health

Som la pera

www.facebook.com/somlapera

UK National Children’s

Bureau

Look Up

www.facebook.com/LookUpIslington

3 Andreasen, A. (2002) Marketing Social Marketing in the Social Change

Marketplace. Journal of Public Policy & Marketing Vol. 21 (1) p. 3–13


http://www.facebook.com/Eytocz

http://www.facebook.com/EytoPortugal

http://www.facebook.com/somlapera

http://www.facebook.com/LookUpIslington



The project involved the following:

Recruitment of Campaign Creators – up to six young people in each country between the ages of 14 to 17 worked together and led the

campaign in each of the four countries. These were recruited by the EYTO management teams4 in each country using specific networks to engage with young people who had an interest in the topic. These young people

will be referred to as Campaign Creators throughout this report. Training and support for Campaign Creators on a variety of topics,

such as social marketing. This was delivered by EYTO management teams and other professionals who aimed to up-skill Campaign Creators and give them the confidence to plan, develop and deliver campaign activities.

Development and delivery of social marketing activities by Campaign Creators, which included face-to-face events and online

activities using website and social media tools. Delivery of activities and information that promoted healthy eating

and physical activities.

Delivery of activities and information targeted at young people in specific localities in each country, but were open to all including adults

and individuals outside each locality.

1.2 Evaluation of EYTO: Aims and methodology Following on from the interim evaluation report (February 2015) that included findings at baseline and interim stages of the evaluation, this is the final evaluation stage of the EYTO project led by the NCB Research Centre. It

evaluates activities against the following initial project objectives:

Young people and practitioners across the four partnerships have increased skills and confidence in applying participatory social marketing

techniques. At least 80 per cent of young people who engage in campaigns will have

increased their motivation to eat more healthily and be more physically

active. At least 60 per cent of young people who engage in campaigns will have

increased their levels of physical activity and fruit and vegetable consumption.

To identify the impact of the project, data was gathered and reported at the

baseline (in August 2014), interim (in January 2015) and final (in July 2015) stages of evaluation. This included a combination of quantitative and qualitative

methods to gather and analyse data on the impact of the campaigns. The following was reported at interim and final stages, with the exception of talking with Campaign Creators which was undertaken at all three stages of evaluation:

4 Professionals from Komunikujeme (Czech Republic); Companhia de Ideias (Portugal);

CTNS Technology Centre of Nutrition and Health (Spain); and National Children’s

Bureau (UK).




Talking with the Campaign Creators, young people who delivered the campaigns.

Talking with professional stakeholders (e.g. EYTO management teams, youth workers, local and national policymakers)

Analysis of all the activities and information that were delivered during the campaigns. This was recorded by Campaign Creators and EYTO management teams using impact spreadsheets.

Analysis of an online survey completed by peers and other audiences who had engaged with the campaigns5.

1.3 Report structure The final stage of evaluation used a combination of quantitative and qualitative

methods to gather and analyse data on the impact of the campaigns. This report has been structured by findings from each different method, as follows:

Impact spreadsheets with activities and information delivered during campaigns completed by Campaign Creators and EYTO management

teams (Section 2). Focus groups with Campaign Creators who were the young people who

delivered the campaigns (Section 3).

A survey with young people and other audiences who engaged with the campaigns (Section 4).

Telephone interviews with stakeholders (Section 5).

The final section (Section 6) includes conclusions and recommendations from

Campaign Creators and stakeholders on how to take forward learning and findings from EYTO campaigns.

Data is reported across the EYTO programme rather than by individual countries to illustrate overarching trends, experiences and progress towards

achieving aims and objectives. However, comparative differences are reported.

5 This online survey was launched in November 2014 and continued until July 2015.




2. Findings: Impact of activities

EYTO management teams and Campaign Creators (young people who delivered

the campaigns) from each country recorded and reported their campaign’s face to face events, web-based and paper-based activities that were delivered and

number of people who had engaged with them using an impact spreadsheet6.

2.1 Activities

Across the four countries 44 distinct activities were recorded of face-to-face events, web-based and paper-based activities (see Figure 1 below) – of which

the most frequently reported activity was 29 events (65.9%). This was followed by 10 website-based (22.7%) and five paper-based activities (11.4%).

Figure 1: Type of activities (Reported by EYTO management teams and Campaign

Creators across four countries)

Campaign Creators and EYTO management teams were also asked how many

times they had delivered each of the distinct events and paper-based activities. Answers showed that these activities were repeated on more than one occasion. This was the case, in particular, for events as across four countries 29 distinct

6 This information, including numbers, is presented as reported by EYTO management

teams and Campaign Creators. The reporting method used across each country varied

and in some cases estimates were provided, rather than exact numbers.




events (see Figure 1, above) were delivered on 52 different occasions (see Figure 2, below). Each campaign’s descriptions of activities is presented in

Table 2, below. Figure 2: Frequency of events and paper activities7 (Reported by EYTO

management teams and Campaign Creators across four countries)

Table 2: Activities delivered (Reported by EYTO management teams and Campaign

Creators across four countries)

7 The UK’s information stand at the youth centre was not included as it was a

continuous activity over 10 months.

Web-based activities were not included in the analysis as these were continuous

activities.




Country Events Web-based Paper-based

Czech Republic

Healthy life style seminars and

lectures

Healthy baking

Open sport class

Facebook

Instagram

Website

Youtube

EYTO

survey

Portugal Picnic

Soup competition

Fitness class

Welcome meeting

Communication workshop

Facebook

Promotional

videos online

Poster and

leaflets

Spain Gymkhana pop-up event

cooking pop-up events

public presentation event

Christmas cooking pop-up event

Photography exhibitions

Science Young Fair of Reus

Sugar beverages workshop

Balanced diet and physical

activity workshop

Nutritional Myths contest

Facebook

Instagram

Youtube

Flyers

UK Pop-up event8

Healthy food tasting challenge

Information stand

Facebook

Twitter

School survey

activity9

Poster and

leaflets

2.2 Number of individuals engaged in activities Across the four countries a total of 9,503 individuals engaged with paper-based activities. Further analysis of the data showed that UK had the most individuals

who used paper-based activities (8,175) as presented in Table 3, below. This was followed by Spain (500), Czech Republic (478), and Portugal (350).

Across the four countries a total of 4,336 individuals engaged with activities which were run as face-to-face events. Further analysis of the data showed that

Spain had the most individuals who accessed these events (3,070). This was followed by Czech Republic (765), Portugal (251), and UK (250).

Across the four countries a total of 2,984 individuals engaged with web-based activities. Further analysis of the data showed that Portugal had the most

participants who used web-based activities (1,370). This was followed by Czech Republic (967), Spain (466), and UK (181).

Table 3: Number of individuals who engaged in activities

8 Pop-up events are face-to-face events that are delivered for a limited time, such as a

few hours, and can be part of a wider event.

9 This survey was developed by UK Campaign Creators aimed to find out about pupils’

attitudes to healthy lifestyle. It is different from the EYTO survey circulated by all

countries.




Country Paper-based Web-based Events Total

UK 8175 181 250 8,606

Spain 500 466 3070 4,036

Czech Republic 478 967 765 2,210

Portugal 350 1370 251 1,971

Total 9,503 2,984 4,336 16,823

Reported by EYTO management teams and Campaign Creators from all four countries

2.3 Duration of event activities

All countries reported that events were the type of activity most frequently delivered by the Campaign Creators compared with paper-based or web-based activities. Duration of events ranged from one to 35 hours across all four

countries, and further breakdown of information showed that duration of events:

in Spain varied from one to 35 hours;

in Czech Republic ranged from two to eight hours; in Portugal, ran between two to four hours; in the UK each of the two events were 7 hours.

The average duration of events spanned from 2.4 hours (Portugal) to 7 hours

(UK, and is presented in Figure 3, below.

Figure 3: Average duration of events10

10 This was calculated by dividing total hours of all events by the frequency of events




Reported by EYTO management teams and Campaign Creators across four countries

2.4 Target audiences

Activities were targeted at particular audiences (see Figure 4, below) and the

most reported audience across four countries was children and young people (27). This was followed by online audience (8), general population (7), parents and families (4), friends (2), and males or females (2).

Figure 4: Target audiences most mentioned (Reported by EYTO management

teams and Campaign Creators across four countries)




2.5 Section overview

This section included a description of the different types of activities delivered as part of the campaigns, which were: face-to-face events, paper-based and web-based activities. These along with the numbers of individuals who have

engaged with the activities have been recorded by the EYTO management teams and Campaign Creators from each country, and a summary of key

findings are included in the box below.

Summary box

The most common type of activity were face-to-face events, followed by

website-based and paper-based activities. The duration of events ranged from one to 35 hours, and included

lectures, workshops and exhibitions.

The most reported web-based activity by all four countries was Facebook. A greater number of events were delivered by all partners than paper-

based activities. A total number of 9,503 individuals engaged with paper-based activities.

This ranged from 350 (Portugal) to 8,175 (UK).

A total number of 4,336 individuals engaged with events. This ranged from 250 (UK) to 3070 (Spain).

A total number of 2,984 individuals engaged with web-based activities. This ranged from 181 (UK) to 1370 (Portugal).

The most reported audience group that activities were targeted at was

children and young people.

The next section (Section 3) will explore the experiences of Campaign Creators,

young people who delivered the campaigns. This will include a summary of findings from the interim report (mid-way through EYTO project). In addition, as part of the




final evaluation, it will include their experiences of the campaigns, the skills they had developed, and their suggestions for taking forward findings and learnings from

the campaigns.




3. Findings: Campaign Creators Focus Groups

Campaign Creators participated in focus groups in their respective countries at the baseline, interim and final stages of evaluation. These focus groups were

facilitated by professionals from the EYTO management teams, except for UK’s one which was facilitated by NCB Research Centre staff11.

Each country organised focus groups with their Campaign Creators and each focus group lasted for 45 to 60 minutes, and each Campaign Creator was asked

to complete three self-assessment forms to show any improvements in their skills and knowledge, what they enjoyed most about taking part, and the

impact of the campaigns. These responses were collated at the end of the focus group for analysis.

At the baseline and interim stages 21 Campaign Creators participated at each stage across the four countries and a summary of findings from the interim

focus groups is presented in section 3.1, below. For the final evaluation, 18 Campaign Creators participated across four

countries: five from Spain; six from Portugal; five from Czech Republic; and two from UK12. Information collated at each of the four focus groups have been

analysed using thematic analysis and presented in sections 3.2 to 3.7, below.

These findings are from the perspective of the Campaign Creators only who reflected on their experiences to identify, explain and evaluate what and how activities were completed; the project impact on themselves, peers and other

audiences; and recommendations for taking forward project findings.

3.1 Highlights from the interim report: Campaign

Creators

An interim report produced in February 2015 included findings from focus groups with Campaign Creators at baseline and interim stages of evaluation. There was one focus group per country, and across the four countries there

were 21 participants at baseline and 21 participants at interim stages of evaluation. The findings from both stages have been analysed and summarised

as follows: Campaign Creators expectations of working on the campaigns were:

A desire to become healthier and motivate others to do so. Create something interesting to share with friends/school peers

11 Due to the busy schedules of UK Campaign Creators, they were asked to participate

in a telephone focus group and their completed self-assessment forms were emailed

back to the English EYTO management team. 12 England had three Campaign Creators, but only two attended the focus group.




Meet new people and learn new skills

Campaign Creators reported improvements in skills and confidence for

using social marketing methods as a result of engaging with the campaigns – in particular with communicating messages; graphic design; logo and website

design.

The interim evaluation suggested recommendations were for Campaign Creators to receive support in the following areas:

Improved understanding of social marketing approaches and how it can be

applied within the wider context of health campaign Improved understanding of how to influence behaviours

The findings from final focus group evaluation, reported in sections 3.2 to 3.7 below, showed that Campaign Creators had improved their understanding of social marketing and as a result were able to identify what they had achieved

and the limitations of using social marketing approach. They were able to reflect on their experiences of working on the campaigns, and describe the skills

and knowledge they had gained, and what they would have liked to improve further. They reflected on the campaigns in a strategic manner and thus were able to provide examples of changes in behaviours and attitudes that they had

observed through their interaction with audiences, and were able to identify what policymakers and practitioners could do to support the campaigns to reach

their objectives. However, it seems that further support could have been provided for them to monitor and evaluate their activities and identify changes in audiences’ behaviours. This could have been accompanied by robust and

standardised approaches to capture and report changes more effectively and be able to compare findings across the four partner countries.

3.2 Final evaluation focus group with Campaign

Creators

3.2.1 Activities completed

Campaign Creators were asked about the experiences of activities they completed throughout the project, including what they enjoyed and did not enjoy. Their responses are noted below.

They reported enjoying the following activities:

Organising and delivering events. This was seen as a way of making sure that their messages were heard and taken on board, and they enjoyed seeing the direct impact of their activities:

"I think it is to be able to engage with the people and get your message across. I think it is easier to get your message across face-to-face rather than through

social media" (Campaign Creator, UK)




Campaign Creators in Spain described their experience of the Pera Chef – activity which was similar to a Master Chef TV show - and expressed how they

enjoyed:

“All the crazy rules, for example you had a surprise ingredient, or you had to do all your recipes with the same ingredient, you had time limit, judges had to try your food” (Campaign Creator, Spain)

Communication of information was considered to be an enjoyable

experience as it enabled participants to put together information and present it to their peers – giving them control over what and how information was presented:

"Lectures in schools, because we can tell them everything we had been taught. And they reacted well, I think better than if we were teachers." (Campaign

Creator, Czech Republic)

Creating the project from the start and watching it evolve was satisfying experience for Campaign Creators who described how they had to think strategically to plan a project.

"I think also when you are in a room and think how we can do something and then you see everything you planned out - it is quite nice to see everything

come together" (Campaign Creator, UK)

Using social media, including Facebook and Instagram, and integrating

them as part of wider project activities.

Most participants could not think of any activities that they did not enjoy.

Spanish participants reflected on all their activities and found one particular activity that they felt could have been better managed by using a different

method for gathering responses from audiences during a question and answer activity:

“Last activity where participants used ringing bells to answer questions because they are too competitive and we weren't able to control all the bells and see

who wanted to answer and who was just messing around. Activity could be improved by taking away the ringing bells away and ask them to raise their hand instead.” (Campaign Creator, Spain)

3.2.2 Support from EYTO management team

Campaign Creators were asked about the experience and views about the support they had received from the EYTO management team – professionals

who had worked closely with them. All Campaign Creators valued the support received from their national EYTO team and returned to them for information,

advice and guidance as and when required throughout the project.




Engagement approaches and the intensity of support for Campaign Creators varied between countries. Both Portugal and UK EYTO management teams

adopted a community-development approach whereby they used youth centres to recruit Campaign Creators and supported them to plan, create and deliver

ideas and materials for activities. Whereas Spain and Czech Republic used educational networks for the recruitment of Campaign Creators and provided them with more intensive support that included ready-made materials for

activities.

Spanish and Czech Republic Campaign Creators found the support they had received for the delivery of project activities to be ‘essential’ and without which the project could not have been be delivered:

“I think, we could not do it by ourselves. Maybe we could create or invent some

ideas, but I guess it would be very difficult to manage it for us.” (Campaign Creator, Czech Republic)

“There were cases where we didn't know how to make some activities and there was always someone from the university to help.” (Campaign Creator, Spain)

Although they were all happy with the support, some identified additional

support they would have preferred to deliver some of the activities, for example two Campaign Creators who wanted support with creating websites would have preferred to shadow a professional to see how websites are developed so that

they could apply what they have learned in their own campaigns.

3.2.3 Challenges

Campaign Creators were asked about whether they come across any challenges

when they developed and delivered the campaigns. The key challenge for all the participants was limited time to work on the project. All of them were full-

time students and found it difficult to meet with each other and deliver activities – and generally to balance their campaign commitments with busy schedules of attending classes, preparing for exams, and home and social activities.

Participants had the following recommendations for young people who may be

asked to deliver a similar campaigns in the future. These include support with project planning, delivery, and monitoring and evaluation, which are as follows:

Project preparation: Undertake research to identify issues of

concerns before delivering activities. The UK Campaign Creators, for

example, produced a logo and then undertook a survey to gather feedback on their logo. In hindsight, however, they would have preferred the survey

to have preceded and shaped the logo design. More interaction with the audience, including both online and face-to-

face interactions.

Create a pool of ideas for activities that can be used throughout the campaign.

Regular meetings and communication with Campaign Creators team members to discuss ideas, plan and deliver activities.




Delegation of tasks to various team members and keeping a record of it was a valuable lesson learned by one of the Campaign Creators wanted to

pass on to possible future participants:

"It’s useful to have written, what had to be done and who had to do it. We

had not use it at the start, but it wouldn´t last long to realize, that it´s not good." (Campaign Creator, Czech Republic)

Passion and interest for the topic and enjoyment of the experience was essential for motivating audiences who could sense motivation from

their speakers:

“If they all have someday a lecture for their peers, they can be sure, that

the peers will immediately recognize if you´re interested or not." (Campaign Creator, Czech Republic)

3.4 Social marketing Campaign Creators were asked to describe their understanding of the term ‘social marketing’ and what social marketing approaches they had used to engage and support audiences. They were able to identify and describe both the

benefits and limitations of using such an approach, which are noted below.

3.4.1 Connecting and cascading motivational messages

Social marketing was an effective approach for connecting and cascading

information and messages directly to their own networks and people that they would not normally meet.

"I think it refers to activities design to give common people a knowledge, which at the same time will be transferred to other common people. For example, we

did it on people of our age, and we intended to adapt this knowledge to pass it to them." (Campaign Creator, Spain)

The online and face-to-face interactions were useful ways of sending out

messages. Finding the right messages to communicate were considered to be ones that motivated individuals to change or adopt positive behaviours and promoted the benefits of doing so. A participant in the UK, for example,

described how she sent regular motivational quotes in the morning using Twitter with the aim of instigating change, and another participant described

the importance of communicating the benefits of change in messages: "You have to explain the advantages of the change, what will happen if there

will be some change. And to motivate for making in. And I think, it was good, that this part was said by us, not by teachers.” (Campaign Creator, Czech

Republic)




3.4.2 Peer-to-peer interaction

Peer-to-peer interaction was considered to be a valuable aspect of social

marketing. Apart from a few who found it difficult to communicate with friends who thought it was not serious, most of other participants thought peers were more likely to listen to messages on this topic from them rather than adults:

"I think that is definitely more effective, if something is told by your peer,

rather than from somebody older you’re younger because the peer understands you the most. And we heard opinions like this, when we had healthy lifestyles lectures at the Primary Schools." (Campaign Creator, Czech Republic)

3.4.3 Tools

Participants were able to identify the benefits and limitations of different social marketing tools – both online and face-to-face tools - and used the ones that

they found to be the most effective for each activity. For example, Facebook and Twitter were used by some campaigns for communicating messages with

ease and to a greater number of people. Whereas pop-up events were preferred by some who liked to see the changes in attitudes of peers and the value of their work:

"Easier to advertise maybe on social media but it's harder to get them to

change them to change behaviour or anything or relate to them. Easier to do that in person.”(Campaign Creator, UK)

"There is certainly a difference between somebody who will come to make some sport or for a lecture and somebody, who is just reading all the stuff at

Facebook page.” (Campaign Creator, Czech Republic)

3.4.4 Limitations for changing behaviour

Limitations of social marketing included negative habits and behaviours of families and peers that had counter-acted the changes that social marketing

aimed to achieve, and the short duration of the campaigns that made it difficult to capture the behaviour changes that were thought to be long-term impact.

Social marketing was seen to be ideal for instigating change, raising awareness, and giving audiences ideas and experience of different and positive lifestyle. It

was felt that social marketing on its own could not guarantee changes in behaviour as decisions to make lifestyle changes was the responsibility of each

individual. A UK Campaign Creator, for example, explained how the campaign had motivated her friend not to eat chips for a week to experience a change in eating habits, but it was her friend’s decision whether to make it a permanent

change.

"You can incite an attitude or behaviour change, but they have to make the final step." (Campaign Creator, Spain)




3.5 Findings from self-assessment tasks: Impact

on Campaign Creators Campaign Creators were asked to complete four self-assessment tasks by

themselves to identify how they had benefited from working on the campaigns. They were specifically asked about the following points and their responses are

noted below:

Previous experiences of tasks completed (Section 3.5.1)

Interest in tasks completed (Section 3.5.2) Whether their skills and confidence had improved over the duration of the

campaign (Section 3.5.3)

Confidence to apply skills (Section 3.5.4)

3.5.1 Activities and prior experience

Campaign Creators were asked whether they had previous experience of the

tasks they had completed as part of the campaigns. Across the four countries and 1713 participants, there were 184 responses (see Figure 5, below) – of

which 119 (64.7%) stated yes a lot of experience compared to 37 (20.1%) and 28 (15.2%) stated yes a bit and no, respectively14.

Further analysis of the data showed that participants had limited or no experience prior to the campaigns of the following work areas: carried out

research with people you have never met before (10); graphic design (10); designed a poster (10); and carried out research (7) – all of which is presented in Figure 5, over the page.

13 One of the Campaign Creators in Portugal did not complete all the self-assessment

tasks, and thus 17 participants have been included in the analysis for tasks in sections

3.5.1, 3.5.2, and 3.5.3 14 These responses do not take in to consideration whether their prior experience

included activities that they had completed from the start of the campaigns.




Figure 5: Prior experience of undertaking activities

Respondents (N=17)15

15An extra response was recorded for organised or helped run an event and there were five non-responses for Designed a website.

One of the Campaign Creators in Portugal did not complete the self-assessment task, and thus 17 participants have been included in the

analysis.




3.5.2 Interest in tasks completed

Participants were asked to rate their interest in the activities they participated

in, and their responses are presented in Figure 6, on the next page. Across the four countries and 17 participants, there were 187 responses (see Figure 6, below), and of which 160 (85.6%) of the total number of responses stated that

they had yes a lot of interest in the particular areas of work compared to 21 (11.6%) and 6 (3.2%) who stated yes a bit and no, respectively.

Further analysis of the data showed that the areas of work that participants had a lot of interest in were: worked with people from other countries (17);

organised or helped run an event (17); given a presentation to lots of people (16); and carried out research with people you have never met before (16).



www.ncb.org.uk page 32 © National Children’s Bureau

September 2015

Figure 6: Interest in activities


16 One of the Campaign Creators in Portugal did not complete the self-assessment task, and thus 17 participants have been included in

the analysis.




September 2015

3.5.3 Skills and confidence development

Campaign Creators were asked about whether they had developed skills and confidence in ten key areas and their responses were compared with ones

recorded at baseline and interim periods of the campaigns (see Table 4, over the page).

Responses show an overall improvement in skills and confidence over the course of the campaigns as self-reported by participants. Across the four

countries there was a total of 237 responses collated at baseline and total of 153 responses collated at wave 3, final evaluation stage. Of the total number of responses - those who had reported no development in skills and confidence

had fallen from 28 (12.1%) at baseline to 14 (9.2%) at wave 3, and those who reported yes a lot had risen from 104 (45%) at baseline to 136 (72.7%) at

wave 3. A higher number of Campaign Creators reported no development in their skills and confidence for designed a poster and designed a logo at wave 3 compared to the baseline.




September 2015

Table 4: Skills and confidence development

Yes, a lot Yes, a little No Total (N)

Organised or helped run an event

Wave 3 16 1 0 17

Wave 2 18 3 0 21

Baseline 15 6 0 21

Carried out research

Wave 3 17 0 0 17

Wave 2 15 5 1 21

Baseline 13 6 2 21

Designed a poster

Wave 3 8 5 4 17

Wave 2 13 7 1 21

Baseline 12 8 1 21

Designed a website

Wave 3 10 5 2 17

Wave 2 8 8 5 21

Baseline 5 13 3 21

Designed a logo

Wave 3 11 2 5 18

Wave 2 13 7 1 21

Baseline 7 11 3 21

Done graphic design

Wave 3 5 11 1 17

Wave 2 8 7 6 21

Baseline 1 8 12 21




Yes, a lot Yes, a little No Total (N)

Drafted written material to get across a key message to lots of people in a snappy or powerful way

Wave 3 10 6 1 17

Wave 2 13 8 0 21

Baseline 7 14 0 21

Given a presentation to lots of people

Wave 3 14 2 1 17

Wave 2 14 7 0 21

Baseline 9 6 6 21

Used social media to communicate message to a wide range of people

Wave 3 12 5 0 17

Wave 2 16 4 1 21

Baseline 7 13 1 21

Carried out a project with people you have never met before

Wave 3 16 0 0 16

Wave 2 16 4 1 21

Baseline 15 6 0 21

Worked with people from other countries

Wave 3 17 0 0 17

Wave 2 18 3 0 21

Baseline 13 8 0 21

Total (N) 392 199 58 649

Respondents (Baseline N=21, Wave 2 N=21, Wave 3 N=17)




September 2015

3.5.4 Confidence to apply skills

Participants were asked to rate their confidence when using seven particular

skills, as presented in Figure 7, below. Across the four countries and 17 participants, there were 125 total responses – of which 106 (85%) were either very confident or confident, compared to 18 (14%) and 1 (0.8%) who indicated

either confident or unconfident or unconfident, respectively.

Further analysis of the data showed that the skills participants felt very confident about were: cultural awareness (reported by 10 participants), using information (10) and communication (9). When they were asked to explain their

responses, they mentioned that these skills were developed when they were given opportunities to do activities that they would not normally do, and

suggested that their confidence could have been developed further if they were given more opportunities to complete similar activities.

Figure 7: Confidence to apply skills


17 One non-response for Communication (17)




3.5.5 How skills were developed and applied

The self-assessment tasks had helped Campaign Creators to reflect on a range

of skills that they had developed as part of the campaigns, and to talk about how these skills were used outside their campaigns– at home, school and in the community. One UK participant, for example, described how she used project

management skills to help her mother organise a charity fundraising activity and was able to do this with confidence.

They also talked about how particular skills had helped them to deliver campaign work. These skills were: communication; collaboration; cultural

awareness; using information; and project management – and all are described in more detail as follows:

Communication Most participants (15) rated their confidence in communication skills as

confident, and talked about completing a broad range of activities:

They gathered information and created tailored key messages for their audiences - peers and professionals – through social media tools and face-to-face interactions. One Campaign Creator described how they thought

about making the messages interesting or humorous to attract the attention of their audiences more effectively:

"When we made it for our peers, it was quite simple to communicate like we normally do it with each other. But if we have to prepare something

similar, for example for small kids, it would be different. Maybe we have to use more pictures. It´s important to know all this at the very beginning." (Campaign Creator, Czech Republic)

They talked and engaged in face-to-face discussions with other Campaign

Creators and audiences. Native English speakers, for example, reviewed the way they spoke English so it was clearer for other European partners and non-native English speakers practised and improved their English

language skills.

They spoke in front of a large group of people, both peers and

professionals with confidence, as one participant explained:

“I never had problems with communication and now I had the possibility to try a presentation in English and I really, really enjoyed it.” (Campaign Creator, Czech Republic)




Collaboration and cultural awareness

Most participants rated their confidence for collaboration (17) and cultural

awareness (15) as either confident or very confident. Exposure to different ways of life and people gave participants better understanding of different cultures and were able to identify similarities between them, such as eating

habits, interests and perspectives.

“You get to realise that in Europe people live more or less equally. We learned that our peers from other countries have the same interests as us.” (Campaign Creator, Spain)

For many participants an improved understanding of different cultures helped

them work collaboratively with their European partners during and outside exchange weekends when they discussed and shared approaches, such as how to engage with audiences in their respective countries. This collaborative

working skill was also used by Campaign Creators in their own country teams along with skills for negotiation and compromise, as explained by a participant:

"What was new for me even if people don´t agree with each other in

everything, there is always compromise, so everybody should be at least satisfied. Well, I don´t know, what else could be done." (Campaign Creator, Czech Republic)

Using information

Most participants (16) rated their confidence with using information as either confident or very confident. Participants described how they had read, reviewed and prepared a lot of information, and presented it in a way that could be

understood by peers - a skill that some participants have limited experience of prior to the project.

“The campaign gave us skills that we may had not used. We got a lot of information that we got from school. There is a lot of information about

childhood obesity at the moment.” (Campaign Creator, Portugal)

UK participants, however, suggested that their confidence in this area could have been improved if they had an expert, such as dietician, to work with and help them decipher medical or technical information and how it can be applied

in the daily lives of individuals.

Project management

Most participants (12) rated their confidence in project management as being either confident or very confident. They talked about how they had learned to




do different elements of project design and management, delegate tasks, and discuss ideas and take them forward.

"This in itself was a whole project. I mean the girls had to kind of discuss where

were going, where we wanted it to go, and what we want the product to show or to do. More you do the better you become at it." (Campaign Creator, UK)

One participant suggested that they would have preferred support with how project impact could be identified so that they could monitor and evaluate

activities.

3.5.6 Changes in behaviours and attitudes

Apart from the development of skills, Campaign Creators were asked to describe the impact of the campaigns on their own behaviours and attitudes. Participants reported improved understanding of why and how to lead healthier

lifestyles, and the impact of unhealthy choices on their bodies, which had influenced their decisions and behaviours. They mentioned how delivering their

own campaign activities made them more conscious of their choices of food, drinks and how much physical activities they undertook in their daily lives.

“Yes. For example, before performing the sugar activity I didn't realize that an energy drink could contain so much sugar. I used to drink some - now I don’t,

but I know people that drink lots of it. At the same time I have changed while trying to make people change. On the weekends I used to drink a couple cans

of Coke, but now I avoid it." (Campaign Creator, Spain) Participants reported changes in behaviours including undertaking more

physical activities and consuming more healthy foods such as fruit and vegetables, reading food nutritional labels while shopping to avoid purchasing

food with excessive amount of sugar, and replacing high calorie snacks with healthier alternatives such as fruit.

Participants also reported thinking about the future impact of unhealthy lifestyle, as one participant explained his rationale for wanting to sleep more

was to reduce the long-term negative impact on his health and not just the immediate consequences of poor sleeping patterns:

"I have started to sleep more, because I have got the information, how harmful it´s in my age. And I recommend it also to other.” (Campaign Creator, Czech

Republic). One participant talked about how she had greater awareness of emotions – her

own and other people’s emotions, and how emotions had an impact on individual’s attitudes and decisions about their health. This insight helped her to




understand how to motivate herself and others to make positive changes in their loves that would help them feel better about themselves.

"I want it to make me feel better. I am more conscious of that. But more than

anything it is how I feel." (Campaign Creator, UK).

3.6 Impact on peers and other audiences

Campaign Creators were asked to rate and talk about the impact of their campaigns on their peers and other audiences, and their rating and responses

are noted below.

3.6.1 Rating impact

Campaign Creators were asked to rate the impact of the campaigns on their

audiences on a Likert scale ranging from 1 to 10, with 10 as an indication of very successful. The findings as presented in Figure 8, below, shows that the

campaigns were thought to have had the most impact, i.e. rated 8, 9 or 10, with providing information and increasing awareness (chosen by 11 respondents). This was followed by changing attitudes (13) and motivating

young people (7). There was a higher rating for change behaviour – increased physical activity (12) compared to change behaviour – eating habits (11), which

could be explained by either more activities delivered to increase physical activity or more of its impact was noted by the Campaign Creators.




Figure 8: Impact of activities on peers and other audiences

Respondents (N=18)

3.6.2 Impact reporting and its limitations

Aside from the estimate number of attendees at events or numbers who accessed online tools, Campaign Creators were unable to provide detailed description of audience profile, such as gender, socio-economic backgrounds,

and age range. They made general observations about who they had reached and groups they would like to have reached. Examples include UK participants

who reached disproportionate number of female users and would have liked to have engaged with both genders, Spanish participants who wished they engaged with students from more institutes, and Czech Republic participants

who wanted to reach people from different areas and age groups.

Campaign Creators made general observations about the impact of their activities, such as questions on Facebook pages that suggested interest in their campaigns, and observations about changes in behaviour and attitudes of

friends and family members.

Overall, there appeared to be limited recording and reporting of impact that were designed and undertaken by Campaign Creators, which made it difficult




for them to say how activities had benefited audiences and how they could be improved. In hindsight, some participants mentioned that they should have

undertaken focus groups or surveys with their audiences to find out more about them and how they had benefited from campaign activities and information.

Their intention was to make the project inclusive for all, but a few considered targeting particular groups to be detrimental to the idea of inclusivity.

3.7 Key findings from each country The wave 3, final evaluation focus groups from all four countries have so far

been analysed together. A summary of key findings from each country has been included below, which helps to draw upon any unique findings that were

specific to each participating country.

3.7.1 Portugal: Key findings

Social marketing: They described social marketing as a useful and

powerful approach when used with purpose, and felt that they had developed knowledge in this particular area.

Development of knowledge and skills: There were six participants in

the final evaluation focus group, but only five completed the self-assessment task on the development of knowledge and skills. When the

five participants were asked whether they had skills and confidence in a range of work areas– most (five participants) stated that yes a lot of confidence and skills in the following five areas: organised or helped run

an event; carried out research; designed a logo; carried out a project with people you have never met before; and worked with people from other

countries. Most (four or five participants) had relatively less confidence and skills in the following three work areas: designed a website; drafted written material to get across a key message to lots of people in a snappy

or powerful way; and used social media to communicate message to a wide range of people.

Confidence in the application of skills: When the six participants in the

final evaluation focus group were asked to rate their confidence in seven key skill areas18, most (five or six participants) felt confident or very

confident about using the following six skills: creativity; collaboration; using information; communication; cultural awareness; and managing

projects.

Impact of the campaigns on their audiences: When the six participants in the final evaluation focus group were asked to rate the

18 Participants were asked to rate their confidence using a scale of: very confident;

confident; neither confident or unconfident; unconfident; and very unconfident.




impact of the campaigns according to various statements – most (six participants) gave a very successful19 rating of 9 or 10 for motivating

young people and change behaviour increased physical activity.

Observations: They self-reported taking up better eating habits and more

exercise, and saw changes in the family and friends with whom they had regular contact with. They felt they had increased their confidence by getting in to contact with other people including ones from other countries

and cultures – the process of listening to their views and giving their own opinions.

Learning: In hindsight they would have preferred to have disseminated

the campaign to more people and outside of their targeted school.

Suggestions for policymakers and practitioners: To change

behaviours of children and young people, they suggested schools should change their food offer; ensure grades for physical education classes is as

important as academic classes; and wider promotion of sports that will motivate young students to participate.

3.7.2 Czech Republic: Key findings

Social marketing: They described social marketing as an effective way to

deliver useful and meaningful information to a large audience, and prompted them to think about how to prepare information in a funny and

interesting way so that it was accessible for their peers of different ages.

Development of knowledge and skills: There were five participants in the final evaluation focus group. When they were asked whether they had

skills and confidence in a range of work areas, most (five participants) stated that yes a lot of confidence and skills in the following three areas:

carried out research; carried out a project with people you have never met before and worked with people from other countries. Most (three participants) had relatively less confidence and skills in the following two

areas of work: designed a logo and done graphic design.

Confidence in the application of skills: When five participants in the

final evaluation focus group were asked to rate their confidence in seven key skill areas, most (four to five participants) felt confident or very confident about using the following four skills: problem solving; creativity;

collaboration; and using information.

Impact of the campaigns on their audiences: When the five

participants in the final evaluation focus group were asked to rate the impact of the campaigns according to various statements – most (four to five participants) gave a very successful rating of 9 or 10 for the following:

19 Using a scale of 1 to 10 where 1 is not at all successful and 10 is very successful.




providing information and increasing awareness and motivating young people.

Observations: They described the difference of using face-to-face and

online interactions – and thought the former was a more effective method

for communicating messages as they were able to see and experience the interaction with audiences. They talked about how their own self-confidence had improved when delivering activities, including ones that

involved public speaking, and had learned how to work together in a team.

Suggestion for policymakers and practitioners: To change behaviours

of children and young people, they suggested that families should provide greater support for healthy lifestyles at home, along with provision of more physical activity in schools, greater availability of healthy foods, and more

playgrounds or opportunities for activities.

Learning: Motivation was thought to be the most important step for

changing of behaviours. This involved finding ways to spark motivation among children and young people, such as popular role models, interesting activities, and working more closely with schools. It was also important for

campaign designers and professionals who delivered information and spoke to audiences to have real motivation and passion for the topic of

obesity as audiences could sense this and it influence their decision to take up information and advice.

3.7.3 Spain: Key findings

Social marketing: They described social marketing as an efficient way to

communicate messages directly to audiences and encourage audiences to interact with the campaign designers that was more than simply explaining

terms and issues.

Development of knowledge and skills: There were five participants in the final evaluation focus group. When they were asked whether they had

skills and confidence in a range of work areas – most (five participants) stated that they had yes a lot of confidence and skills in the following eight

work areas: organised or helped run an event; carried out research; designed a website; drafted written material to get across a key message to lots of people in a snappy or powerful way; given a presentation to lots

of people; used social media to communicate message to a wide range of people; carried out a project with people you have never met before; and

worked with people from other countries. Most (four participants) reported relatively less confidence and skills in the following three work areas: designed a poster; designed a logo, and done graphic design.

Confidence in the application of skills: When five participants in the final evaluation focus group were asked to rate their confidence in seven

key skill areas, and most (four or five participants) felt confident or very




confident about using the following six skills: creativity; problem solving; communication; collaboration; using information; and cultural awareness.

Impact of the campaigns on their audiences: When the five

participants in the final evaluation focus group were asked to rate the

impact of the campaigns according to various statements – most (four or five participants) gave a very successful rating of 9 or 10 in providing information.

Observations: They talked about developing greater confidence and skills for communicating technical information to audiences, such as nutrition

values and its importance to younger children. They also reported improving their English language skills – all of which helped them to reflect and refine their key messages for their audiences and when they

interacted with Campaign Creators from other countries.

Suggestion for policymakers and practitioners: To change behaviours

of children and young people, they suggested more resources and time had to be invested in initiatives for more impact. Although they had good support, resources and materials, but everything has limits. They required

more time to perform activities and resources to put all this ideas in few time.

Learning: Campaigns provide information and ideas, but it is the

individual who has to make the final decision to change their attitudes and

behaviours and take up a more healthy way of living.

3.7.4 UK: Key findings

Social marketing: They described it as an effective way to raise awareness of issues and start discussions about the topic of obesity among

children and young people, parents, and professionals. This was considered to be an important part of the process of changing behaviours.

Development of knowledge and skills: There were two participants in

the final evaluation focus group. When they were asked whether they had skills and confidence in a range of work areas – both participants stated

that they had yes a lot of confidence and skills in the following eight work areas: organised or helped run an event; carried out research; designed a poster; designed a logo; drafted written material to get across a key

message to lots of people in a snappy or powerful way; given a presentation to lots of people; used social media to communicate message

to a wide range of people; and worked with people from other countries. Both participants reported relatively less confidence and skills in the following three work areas: designed a website; done graphic design; and

carried out a project with people you have never met before.

Confidence in the application of skills: When two participants in the

final evaluation focus group were asked to rate their confidence in seven




key skill areas, and both participants felt confident or very confident about using the seven skills.

Impact of the campaigns on their audiences: When the two

participants in the final evaluation focus group were asked to rate the

impact of the campaigns according to various statements – both participants gave a successful rating of 8 in changing behaviour – increased physical activity.

Observations: They talked about particular behaviours and habits of female and male audiences. They, in particular, noticed that girls and

young women were less likely to participate in physical activities, unlike boys and young men. It was seen to be important to understand why girls and young women were less motivated to participate in sports, and how to

increase their participation in such activities.

Suggestion for policymakers and practitioners: Campaigns should be

accompanied by the provision of resources and places for children and young people to participate in activities so that they can change their behaviours.

Learning: A key aspect of changing behaviours and habits is tapping in to the emotions of audiences, as positive emotions were more likely to

motivate and encourage individuals to take action. Positive and inspirational messages communicated by the campaigns were considered

to bring better engagement and lead to positive actions of audiences.

3.8 Suggestions for practitioners and

policymakers Campaign Creators were asked whether they had any suggestions or

recommendations for practitioners and policymakers on how the campaigns could be improved and how to ensure permanent changes to obesity rates. Their responses are noted below.

3.8.1 Motivation and practical information for change

There was general agreement among participants that change in behaviours could only occur if individuals have a personal commitment and motivation for

change. Motivation was seen to be the key for encouraging individuals to take action towards tackling obesity and leading healthy lifestyles. Participants

worked on activities with the aim of sparking motivation in audiences, which involved firstly creating messages and activities that would capture the attention of people and connect with them in an emotional way. This was

followed by practical information on how to create changes in their daily lives – changes to certain aspects of their lives rather than changing everything.




"If they don’t get interested and you don’t make the message attractive then

there’s no motivation neither of them nor of you. For example, if you go to perform an activity and you do it with motivation and they feel your energy,

they will feel motivated as well. It’s nice to learn something like that and maybe they do it.” (Campaign Creator, Spain)

3.8.2 Provision of reliable and accessible information

The provision of accurate and reliable information was crucial and many Campaign Creators participants mentioned how they valued working with professionals to find appropriate and correct information. However, what made

information accessible and user-friendly information for peers was the personal touch Campaign Creators added to it, such as information with commentary and

advice on how best to make changes in lifestyle, and events that included demonstrations and thought-provoking discussions. Examples of these include fun pop-up events with taste testing activities and social pages that monitored

exercise challenges of Campaign Creators.

3.8.3 Resources and opportunities to make healthy choices

Provision of information and advice on its own was not considered to be enough

to create permanent changes in obesity rates. Participants suggested information had to be accompanied with access to resources such as healthier

foods and spaces for free physical activities, so that people can start making real changes in their lives and have the places and support to do so.

3.8.4 Support from various sources

Children and young people were thought to require support and encouragement from family, schools and professionals in various settings so that they have

access to support in their lives to make healthy choices whether it is at home, school or community. People in the home and community who were leading healthy lifestyle were considered to be role models who were showing others

how to lead a healthy lifestyle and the benefits of doing so. This was seen as a good way of motivating children and young people to make choices similar.

One participant, for example, explained that as result of the campaign her mother replaced white with brown rice, pasta and bread and reduced take away

meals which made it easier for her to make healthy choices. Another participant reported that her family took more walks in countryside which

encouraged her to do the same.




3.9 Section overview This section included Campaign Creators’, young people who delivered the

campaigns, experiences of working on the campaigns, opinions on issues regarding obesity, skills they had improved as a result of the campaigns, and

suggestions for taking forward findings from the campaigns. It also included a summary of findings from interim report and key findings from each country. A summary of key findings are included in the box below.

Summary box

Activities

Campaign Creators enjoyed a range of activities, including organisation

and delivery of events and communication of information. They also

identified activities that they did not enjoy and suggested support in further areas such as website development.

Campaign Creators reported that they received support from the EYTO

management team, but approaches and intensity of support varied between countries.

Challenges

A key challenge for all Campaign Creators related to having limited time to work on the project, as they had to balance their EYTO project

commitments with busy schedules of attending classes, preparing for exams, and home and social activities.

Social marketing

Social marketing was an effective approach for connecting and cascading information and messages directly to their own networks and people that

they would not normally meet.

The most effective messages to communicate were positive and

inspirational ones that promoted the benefits of healthy lifestyles. These were considered more likely to motivate individuals to make positive changes in their behaviours.

Negative habits and behaviours of families and peers were considered to be counter-productive to social marketing that encouraged healthy

lifestyles.

Social marketing provides information, but the decision to take up advice and information that lead to healthy behaviours is the responsibility of

each individual.

Impact on Campaign Creators

Campaign Creators undertook a range of activities during the campaigns,

and they were asked about their prior experience. When asked about their interest in the activities - 160 (85.6%) of the total number of responses




showed that they had yes a lot of interest in the particular areas of work compared to 21 (11.6%) and 6 (3.2%) who stated yes a bit and no,

respectively. The areas of work that they had the most interest in were: worked with people from other countries; organised or helped run an

event; carried out a project with people you have never met before; and given a presentation to lots of people.

Campaign Creators rated their confidence when using seven particular

skills - 106 (85%) of the total number of responses were either very confident or confident compared to 18 (14%) and 1 (0.8%) who indicated

neither confident or unconfident and unconfident, respectively. The areas of work that they felt very confident about applying skills were: cultural awareness; using information; and communication.

Campaign Creators were asked about whether they had developed skills and confidence in ten key areas and their responses were compared with

ones recorded at baseline, interim periods of the campaigns. They self-reported an overall improvement in skills and confidence over the course of the campaigns. Of the total number of responses - those who had

reported no development in skills and confidence had fallen from 28 (12.1%) at baseline to 14 (9.2%) at (wave 3), and those who reported yes

a lot had risen from 104 (45%) at baseline to 136 (72.7%) at wave 3. There were improvements reported in the following skills:

communications; cultural awareness; collaboration; using information; and project management.

Impact on peers and other audiences

Campaign Creators rated the project impact on their audiences using a

Likert scale ranging from 1 (not at all successful) to 10 (very successful).

Findings showed that campaigns had the most impact, i.e. rated 8, 9 or 10, with providing information and increasing awareness (chosen by 11 respondents). This was followed by changing attitudes (13) and motivating

young people (7).

Limited impact recording and reporting

There appeared to be limited recording and reporting of impact by

Campaign Creators which made it challenging to capture impact on audiences, in particular what and how behaviours have been changed as a

result of the campaigns, and which groups have benefited the most from the campaigns.

The next section (Section 4) will explore the experiences of children and young

people and other audiences who have engaged with the campaigns, and their attitudes and behaviours regarding healthy eating and physical activities.




4. Findings: Survey with children and young people and other audiences

4.1 Introduction to survey Audiences who engaged with campaigns in their respective countries were asked to complete an online survey that aimed to find out about their views and

experiences on obesity, healthy eating and physical exercise.

The survey was launched and uploaded online in November 2014 at the start of the campaigns by EYTO management teams in their own languages for

audiences to complete in their own time, and it was closed in July 2015. This survey aimed to gather views on the causes of obesity; barriers and enablers for healthy lifestyles; and effectiveness and impact of the campaign. Audiences

who had engaged with campaigns either online or at face-to-face events were asked to complete the online survey. Paper-based surveys were also used by

some teams to increase the response rate.

Findings from the survey are included in this section and wherever percentages are reported – these have been calculated from valid answers from respondents who answered the questions and excluded non-substantive responses, e.g. I

don’t know.

4.2 Survey respondents

This survey was completed by 237 respondents across four countries: Spain, Portugal, Czech Republic and UK. The number of respondents who completed

the survey in each country are as follows: Czech Republic (88); Spain (71); Portugal (53); and UK (25).

Of the 237 total respondents – 168 (71%) of them were female (see Figure 9, below), and 136 (58%) were between the ages of 14-19 years and 59 (25%)

were over the age of 25 (see Table 5, below).




Figure 9: Gender of respondents

Respondents (N=237)

Table 5: Age of respondents

Czech

Republic

Portugal Spain UK Total

Under 10 years old 4 1 0 2 7

11-13 9 4 7 2 22

14-16 37 13 46 8 104

17-19 11 10 3 8 32

20-22 2 4 1 2 9

23-25 2 0 2 0 4

Over 25 years old 23 21 12 3 59

Total 88 53 71 25 237

Respondents (N=237)

Of 237 total respondents, 178 (75%) reported that they were in education

(either school or university), as presented in Figure 10, below. Of the 74 (31.2%) in employment – 43 (18.1%) and (13.1%) were in full-time and part-

time employment, respectively.




Figure 10: Education of respondents

Respondents (N=237)

4.3 Respondents engagement with activities

The survey aimed to find out which campaign activities respondents had engaged with to identify most effective engagement approaches. Their responses are noted below.

Respondents were asked whether they had engaged with any campaign

activities or received any information (see Table 6, below). Across the 197 respondents who answered this question, there were 387 responses – of which Facebook was the most common answer by 158 (40.8%) respondents. This was

followed by 64 (16.5%) who used pop-up event, 46 (11.9%) who used online video/youtube, and 41 (10.6%) who used leaflets.

Further analysis of the data suggests that aimed to find out what activities audiences engaged with found that web-based activities (Facebook, online

video/youtube, Instagram, Twitter) were the most effective approach for engagement as these had combined responses of 232 (59.9%), when compared

with events (pop-up events) which had 158 (40.8%) responses and paper-




based activities (leaflet, posters, newspaper advert, and postcard) which had combined responses of 91 (23.5%)20.

Table 6: Respondents engagement in activities

Czech

Republic


Facebook page 70 31 52 5 158

Pop up event 19 8 29 8 64

Online video / YouTube 12 13 19 2 46

Leaflet 17 8 12 4 41

Instagram 15 0  5 4 24

Posters 6 6 7 4 23

Newspaper advert 8  0 10 1 19

Postcard  0 1 6 1 8

Twitter feed 3 0  1 0  4

Total 150 67 141 29 387

Respondents (N=197). Respondents could choose more than one response.

4.4 Impact on behaviours

The survey aimed to find out the impact of the campaigns on audiences’ behaviours regarding eating and undertaking physical activities, and their responses are noted below.

Respondents were asked questions about the impact of the campaigns on their

habits and behaviours associated with eating and physical activity. Of the 237 respondents, 213 (89.9%) rated campaigns as either somewhat

effective or very effective in encouraging them to eat a more healthy diet and be more physically active, and findings are presented in Table 7, below.

20 Of the 40 who did not select any answers, 9 stated I can’t remember, 9 stated I don’t

know, and 31 stated none of these. In a small number of cases, respondents who

selected answers activities also selected I can’t remember (2) and none of these (3).

Their reported activities were included in the analysis.




Table 7: Effectiveness for encouraging young people to eat a more healthy diet

and be more physically active

Czech

Republic


Very effective 28 23 25 10 86

Somewhat effective 49 27 38 13 127

Not very effective 7 3 6 0 16

Not at all effective 4 0 2 2 8

Total 88 53 71 25 237


Respondents were also asked to rate the campaigns’ effectiveness on whether it

had engaged, communicated, motivated and demonstrated for audiences to eat a more healthy diet and be more physically active. Responses (see Table 8,

below) showed that most respondents considered the campaigns to be either very effective or somewhat effective in all the following areas:

Encouraging young people to eat a more healthy diet and be more physically active

Encouraging young people in eating a healthy diet and becoming physically

active Communicating why it is important to eat a healthy diet and be physically

active Motivating young people to eat a healthy diet and be physically active Showing young people how to eat a healthy diet and be physically active

through practical suggestions for their day-to-day life

Across the 237 respondents who answered these questions there were 1,185 responses – of which 605 (51.1%) indicated somewhat effective and 444 (37.5%) indicated very effective.




Table 8: Campaign Effectiveness

Czech

Republic Spain Portugal UK Totals

Very

effe

ctiv

e

So

mew

hat

effe

ctiv

e

No

t very

effe

ctiv

e

No

t at a

ll

effe

ctiv

e

Very

effe

ctiv

e

So

mew

hat

effe

ctiv

e

No

t very

effe

ctiv

e

No

t at a

ll

effe

ctiv

e

Very

effe

ctiv

e

So

mew

hat

effe

ctiv

e

No

t very

effe

ctiv

e

No

t at a

ll

effe

ctiv

e

Very

effe

ctiv

e

So

mew

hat

effe

ctiv

e

No

t very

effe

ctiv

e

No

t at a

ll

effe

ctiv

e

Very

effe

ctiv

e

So

mew

hat

effe

ctiv

e

No

t very

effe

ctiv

e

No

t at a

ll

effe

ctiv

e

Encouraging young people to eat a more healthy diet and be more physically

active

28 49 7 4 25 38 6 2 23 27 3 0 10 13 0 2 86 127 16 8

Engaging young people in eating a healthy diet and becoming physically active

28 47 10 3 18 32 3 0 20 37 9 5 12 11 0 2 78 127 22 10

Communicating why it is important to eat

a healthy diet and be physically active

28 49 9 2 24 25 4 0 26 39 6 0 6 16 1 2 84 129 20 4

Motivating young people to eat a healthy diet and be physically active

39 39 7 3 25 24 4 12 26 33 10 2 10 12 1 2 100 108 22 7

Showing young people how to eat a

healthy diet and be physically active through practical

suggestions for their day-to-day life

36 36 13 3 22 29 2 0 29 36 6 0 9 13 1 2 96 114 22 5

Respondents (N= 237)




September 2015

4.5 Current behaviours and attitudes

The survey aimed to find out about respondents’ current behaviours and whether they wanted to make positive changes to their lifestyles. Their

responses are noted below.

Respondents were asked to choose a statement that best described their behaviours and intentions for making any changes at the time they completed the survey. The findings (see Table 9, below) showed that 165 (69.6%)21,

wanted to make changes in their diet and exercise routine – of which 113 (47.7%) felt that they were already leading healthy lifestyle and 52 (21.9%)

who described their lifestyle as being unhealthy.

Table 9: Self-description of respondents

Czech

Rep

ub

lic

Po

rtu

gal

Sp

ain

UK

To

tal

I live in healthy lifestyle but I still want to make some

changes to my diet and exercise routine 34 26 40 13 113

I don't live a very healthy lifestyle at all and I want to

make some changes to my diet and exercise routine 24 17 7 4 52

I live a healthy lifestyle and I don't need to make any

changes to my diet and exercise routine 14 8 21 7 50

I don't know 8 1 2 1 12

I don't live a very healthy lifestyle and I don't want to

make any changes to my diet and exercise routine 8 1 1 0 10

Total 88 53 71 25 237

Respondents (N=237)

4.6 Taking forward learning from the campaigns

The survey aimed to find out how respondents had used the information and learnings from the campaigns and whether they applied them in their everyday

lives. Their responses are noted below.

Most respondents indicated that they thought, talked and shared information about the campaigns. Across the 216 respondents, there were 402 responses (see Figure 11, below) – of which 99 (24.6%) respondents thought about eating

a healthy diet and being physically active. This was followed by 97 (24.1%) who talked about the campaign with a friend/parent 41 (10.2%) and 72 (17.9%)

21 This a combination of the two statements: I live in healthy lifestyle but I still want to

make some changes to my diet and exercise routine and I don't live a very healthy

lifestyle at all and I want to make some changes to my diet and exercise routine




who shared the link about the campaign or information about the campaign with a parent/friend.

Fewer respondents indicated taking actions as a result of the campaigns, for

example 42 (10.4%) stated that they made a change to eat a more healthy diet and be more physically active and 57 (14.2%) tried to find out more about healthy eating or being physical active22.

22 Apart from the 21 respondents who did not answer this question - 14 respondents

indicated none of the above and 8 stated I don’t know. Of the respondents who

reported I don’t know, one also chose nothing yet- maybe later which suggests that the

respondent may not have understood the question.




September 2015

Figure 11: How the respondents have taken forward the campaigns





4.7 Views on obesity and healthy lifestyles The survey aimed to find out about respondents’ views on what they thought were the causes of obesity, and factors that can help and deter children and

young people from leading healthy lifestyles. They were given various factors to choose from and their responses are noted below.

4.7.1 Causes of obesity

Across the 237 respondents, there were 1,330 responses – of which the most

indicated answer by 188 (14.1%) respondents was eating too much unhealthy food. This was followed by not doing enough physical activity and being lazy indicated by 168 (12.6%) and 130 (9.8%) of respondents, respectively.

This question was followed by one that asked respondents to choose factors

that they thought were the most important. Across the 237 respondents there were 539 responses – of which the most indicated answers by 130 (24.1%) respondents was still eating too much unhealthy food and not doing enough

physical activity by 115 (21.3%).

Further analysis of the responses (see Table 10) showed that behaviours associated with eating and physical activity were considered to be the main

causes of obesity. Of the 539 total number of responses – 262 (48.6%) were associated with eating i.e. consuming too much food, unhealthy foods or not eating healthy foods23, and 178(33%) of responses were associated with not

taking enough physical activities24.

Fewer respondents considered causes associated with poor health, disability and genetics as contributing to obesity, as having a medical condition, having a disability and genetics were indicated by 16 (3%) of respondents. This suggests

that causes of obesity – in particular eating and physical activity - were thought to be in the control of individuals rather than external factors that were beyond

their the influence and control.

23 This refers to the following answers in Figure 10: eating too much unhealthy food;

not eating enough fruits and vegetables; other people eating unhealthily around them;

eating too much generally; and parents/carers only providing unhealthy food 24 This refers to the following answers in Figure 10: not doing enough physical activity;

being lazy; and sitting down a lot.




Table 10: Most important causes of obesity

Czech

Rep

ub

lic

Po

rtu

gal

Sp

ain

UK

To

tal

Eating too much unhealthy food 42 29 45 14 130

Not doing enough physical activity 46 25 40 4 115

Not eating enough fruits and

vegetables 16 11 16 1 44

Being lazy 24 8 6 4 42

Other people eating unhealthily

around them 18 16 6 0  40

Eating too much generally 7 4 10 5 26

Boredom 11 3 5 6 25

Parents/carers only providing

unhealthy food 3 9 9 1 22

Sitting down a lot 7 8 5 1 21

Feeling down 5 6 4 3 18

Being lonely 5 6 4 0 15

Healthy food is expensive 4 7 0  3 14

Genetics 7 2 5 0 14

Being unlucky 5 1 0  0  6

Lack of information about how to

lose weight 1 1 2 1 5

Having a disability 1 0  0 0  1

Result of a medical condition  0 0  1 0  1

Total 202 136 158 43 539





4.7.2 Factors that help young people make healthy choices

and live a healthy lifestyle

Respondents were asked what factors help children and young people make healthy choices and live a healthy lifestyle. Across the 237 respondents – there

were 1,248 responses – of which the most indicated answer by 158 (12.7%) respondents was support from their parents/carers to get healthy. This was

followed by access to opportunities for sports and other physical activities and enjoying physical activity indicated by 153 (12.3%) and 129 (10.3%) respondents, respectively.

This question was followed by one that asked out of all the factors mentioned,

which ones they thought were the most important. Across the 237 respondents there were 521 responses – of which the most indicated answer by 101 (19.4%) respondents was support from their parents/carers to get healthy. This

was followed by access to opportunities for sports and other physical activities and enjoying physical activity indicated by 70 (13.4%) and 61 (11.8%) of

respondents, respectively. Further analysis of the responses (in Table 11, below) showed that out of the

521 total responses – 194 (37.2%) was associated with support, in particular support from personal and social networks, such as parents and friends25. The

enjoyment of activities and healthy foods were also considered to be important as 108 (20.5%) of total number of responses were linked to enjoying physical activity and enjoying healthy eating, and 100 (19.2%) of responses referred to

access to opportunities and resources, i.e. access to opportunities for sports and other physical activities and access to healthy food.

25 This refers to the following answers in Table 12: support from their parents/carers to

get healthy; having someone to exercise with; support from their friends to get

healthy; and support from school to get healthy.




Table 11: Most important factors that help young people make healthy choices

and live a healthy lifestyle

Czech

Rep

ub

lic

Po

rtu

gal

Sp

ain

UK

To

tal

Support from their parents/carers to get

healthy

35 29 28 9 101

Access to opportunities for sports and other

physical activities 31 14 20 5 70

Enjoying physical activity 25 15 19 2 61

Caring about the way they look 22 14 11 3 50

Enjoying healthy eating 6 16 20 5 47

Having someone to exercise with 20 4 11 4 39

Seeing the benefits from making healthy

choices 8 13 12 4 37

Support from their friends to get healthy 18 10 5 0  33

Access to healthy food 7 8 11 4 30

Knowledge and understanding of how to be

healthy 10 5 10 2 27

Support from school to get healthy 8 6 5 2 21

Having time to think about being healthy 3 1 1   0 5

Total 193 135 153 40 521


4.7.3 Factors that deter children and young people from making healthy choices and living a healthy lifestyle

Respondents were asked what factors deterred children and young people from making healthy choices and living healthy lifestyle. Across the 237 respondents, there were 1,446 responses – of which the most indicated answer by 139

(9.6%) of respondents was not getting enough exercise. This was followed by lacking motivation to change and lack of will power indicated by 127 (8.9%)

and 119 (8.2%) of respondents, respectively. This question was followed by one that asked which of the factors mentioned,

were considered to be the most important. Across the 237 respondents there was 544 responses – of which the most indicated answer by 69 (16.9%) was

being with friends who eat unhealthily. This was followed by not enough healthy meals available in schools and lack of discipline indicated by 52 (12.7%) and 51 (12.5%) of respondents, respectively.




Further analysis of responses (in Table 12) showed that out of the 544 total responses – 233 (42.8%) was associated with motivation for making changes

and adopting new behaviours26. Knowledge and understanding of how to lead a healthier life, such as not knowing how to cook, not knowing enough about

calories, and hidden sugar and salt in food, were considered to be of value, but only 28 (5.1%) thought they were important factors that deter children and young people from making healthy choices.

26 This refers to the following answers in Figures 14a and 14b: lacking motivation to

change; lack of will power; not liking working out; not being able to break bad eating

habits; temptation; and lack of discipline.




Table 12: Most important factors that deter children and young people from

making healthy choices and living a healthy lifestyle

Czech

Rep

ub

lic

Po

rtu

gal

Sp

ain

UK

To

tal

Lacking motivation to change 27 11 24 1 63

Not getting enough exercise 19 14 19 6 58

Lack of will power 17 10 15 0 42

More unhealthy than healthy food in the house 19 13 9 0 41

Not liking working out 12 14 13 1 40

Lack of support friends friends/family to make

changes 10 11 16 1 38

Not being able to break bad eating habits 15 4 16 1 36

Unhealthy foods are cheaper than healthy foods 13 7 8 7 35

Enjoying unhealthy foods more than healthy

foods 7 12 7 8 34

Temptation 4 10 13 5 32

Being with friends who eat unhealthily 6 15 5 2 28

Lack of discipline 13 4 3 0 20

Not enough healthy meals available in schools 6 4 1 0 11

Not knowing how to cook 3 3 4 1 11

Being too busy 4 3 2 2 11

Not having access to a place to work out 4 2 2 2 10

Medical condition 4 0 5 0 9

Hidden salt and sugar in foods 2 2 3 2 9

Not having the time to make changes 6 0 1 1 8

Not knowing enough about calories 3 0 1 4 8

Total 194 139 167 44 544



This section presented the responses of 237 peers and other audiences who have engaged with the campaigns. It shows their experiences and attitudes

regarding healthy eating and physical activities, and what they thought were the factors that could help and deter children and young people from leading healthy lifestyles. A summary of key findings are included in the box over the

page.




Summary box

Activities

Of the 197 respondents who stated that they had engaged with at least

one campaign activities, the most indicated response was Facebook (40.8%).

Answers suggest that web-based activities Facebook, online

video/youtube, Instagram, Twitter) were the most effective approach for engagement as these had combined responses of 232 (60%), when

compared with events and paper–based activities.

Impact on behaviours

Of the 237 respondents, 213 (89.9%) rated campaigns as either

somewhat effective or very effective in encouraging them to eat a more healthy diet and be more physically active.

Respondents were also asked to rate the campaigns’ effectiveness on whether it had engaged, communicated, motivated and demonstrated for

audiences to eat a more healthy diet and be more physically active. Across the 237 respondents who answered these questions there were 1,185

responses – of which 605 (51.1%) indicated somewhat effective and 444 (37.5%) indicated very effective.

Current behaviours and attitudes

Most respondents (165, 69.6%), wanted to make changes to their diet and

exercise routine - of which 113 (47.7%) felt that they were already leading

a healthy lifestyle and 52 (21.9%) described their lifestyle as being unhealthy.

In regards to taking forward learning from the campaigns – most

respondents indicated that they thought, talked and shared information about the campaigns. For example across the 216 respondents, there were

402 responses – of which 99 (24.6%) respondents thought about eating a healthy diet and being physically active. This was followed by 97 (24.1%) who talked about the campaign with a friend/parent 41 (10.2%) and 72

(17.9%) who shared the link about the campaign or information about the campaign with a parent/friend. In comparison fewer respondents indicated

taking actions as a result of the campaigns, for example 42 (10.4%) stated that they made a change to eat a more healthy diet and be more physically active.

Causes of obesity

Factors mentioned include 130 (24.1%) respondents who indicated eating

too much unhealthy food. This was followed by not doing enough physical activity as indicated by 115 (21.3%).

Further analysis of responses showed that behaviours associated with

eating and physical activity were considered to be the main causes of obesity – 262 (48.6%) of responses were associated with eating i.e.




consuming too much food, unhealthy foods or not eating healthy foods, and 178(33%) of responses were associated with not taking enough

physical activities.

Factors that help young people to make healthy choices and live

healthy lives

The most important factors mentioned indicated by 101 (19.4%) respondents was support from their parents/carers to get healthy. This

was followed by access to opportunities for sports and other physical activities and enjoying physical activity indicated by 70 (13.4%) and 61

(11.8%) of respondents, respectively.

Further analysis of the responses showed that 194 (37.2%) responses were associated with support, in particular support from personal and

social networks. The enjoyment of activities and healthy foods was indicated by 108 (20.5%) respondents, and 100 (19.2%) respondents

referred to access to opportunities and resources.

Factors that deter young people from making healthy choices and live healthy lives

The most important factor as indicated by 69 (16.9%) responses was being with friends who eat unhealthily. This was followed by not enough

healthy meals available in schools and lack of discipline indicated by 52 (12.7%) and 51 (12.5%) respondents, respectively.

Further analysis of responses showed that 233 (42.8%) responses were

associated with motivation for making changes and adopting new behaviours. Knowledge and understanding of how to lead a healthier life,

such as not knowing how to cook and not knowing enough about calories, were considered to be of value, but only 28 (5.1%) thought they were

important factors.

The next section (Section 5) will explore the experiences and views of

stakeholders on their understanding of obesity, use of social marketing as a tool for tackling obesity, and suggestions on how to support children and young

people to lead healthy lives. It also includes a summary of key findings from a focus group with EYTO management teams across four countries, which featured in the interim report.




5. Findings: Stakeholders

Comments and suggestions from stakeholders (e.g. local and national

policymakers, youth workers) were collated and analysed at interim and final stages of evaluation.

At the interim stage, EYTO management staff - professionals who supported Campaign Creators – from all four countries participated in one focus group,

and a summary of key findings is included in section 5.1, below.

At wave 3, the final evaluation 22 stakeholders were interviewed across the four countries: six in England; six in Spain; five in Portugal and five in Czech Republic. Each of the four countries interviewed stakeholders who showed an

interest in the EYTO project because they either worked on issues regarding the health of children and young people, or were involved in the development and

delivery of the project. Stakeholders included professionals who work in the voluntary and community sector, such as youth workers; education sector, such as university and school staff; communications sector; and local and national

health strategic bodies. These were telephone interviews organised and undertaken by EYTO management teams in each country, except in the UK

where interviews were undertaken by the NCB Research team. Interviews aimed to gather stakeholders’ views on the issue of obesity, EYTO

project and its impact, use of social media, social marketing as a tool for addressing obesity, and suggestions for how to take forward learning from the

campaigns. The findings from these interviews are analysed in sections 5.2 to 5.9, below.

5.1 Highlights from the interim report: EYTO

management teams The interim report produced in February 2015 included findings from a focus group with stakeholders – four members of staff from the EYTO management

teams across four countries. This focus group took place at the interim stage of evaluation in October 2014 in London, and a summary of issues discussed by

the group are as follows: EYTO management teams had the following overarching objectives across all

four countries:

Raise awareness of obesity among children and young people

Build evidence Change behaviours.

EYTO management teams discussed and identified the following early

outcomes of the campaigns:




How to use social media to communicate serious messages and not only for exchanging messages with friends about social matters –and the

limitations of doing so. How to develop content for social media

The context of the issues at the national and European levels

EYTO management teams discussed how to use social marketing as a tool

for health development work. Suggested approaches were to:

Provide or connect with existing tangible services that underpin campaign activities so that audiences could access services and other support that

will enable them to change their behaviours. Understand children and young people’s access to social media and how it

is used by them. The assumption that all children and young people have access to and use social media was not considered to be correct. They also found supporting Campaign Creators to be challenging as they were often

users rather than content creators and thus required a different set of skills and way of thinking to develop content for their peers.

Find ways to bring together the interests and concerns of different stakeholders, including children and young people, policymakers and health experts, so that information and activities produced will motivate

and encourage them to interact and participate with the campaigns.

EYTO management teams explored how to support youth-led social

marketing work, and their way forward included the following:

Develop a bespoke approach for engaging with and involving Campaign Creators across different countries that took in to consideration their

circumstances and backgrounds Actively manage content creation to ensure information was relevant and

timely. Bring people together, which included exchange weekends that brought

together Campaign Creators, or activities that brought together

stakeholders such as parents, practitioners and policymakers. This was seen to foster discussion on how to address the issue of obesity among

children and young people that involved a range of people from different sectors and at the community, national and European levels.

Balancing youth-led approaches with the need to achieve project outcomes so that Campaign Creators were encouraged to be creative and innovative, but they also understood the outcomes of the project and what the

activities should aim to achieve.

The issues raised by EYTO management teams are discussed in more detail by

a range of stakeholders in the final stage of evaluation in sections 5.2 to 5.9, below. This includes discussions on social, cultural and economic issues that have contributed to poor diets and limited physical activities among children

and young people, and what interventions are required to promote healthy lifestyles.




5.2 Obesity: Populations most at risk

Stakeholders were asked what groups were most at risk in society and why they thought this, and their responses are noted below.

5.2.1 Populations most at risk of obesity

Stakeholders thought that individuals at greater risk of obesity were ones who had experienced one or more of the following factors:

Poverty

Negative health behaviours, such as smoking and excessive consumption of alcohol

Sedentary lives with no or limited physical activities

Limited interactions with health professionals

Two stakeholders thought that the issue of obesity was a national issue that

could affect anyone in their country and not just certain communities or groups. They explained that over-eating and consistent consumption of unhealthy foods

could affect anyone regardless of socio-economic background, and thus required different approaches to reach all groups in society - including those from wealthier backgrounds who have access to the right foods, information

and opportunities but make unhealthy decisions.

5.2.2 Children and young people at risk of obesity: Choice and parental influence

Level of risk faced by children and young people were considered to be either greater or on par with adults. However, the type of risk experienced by children and young people were thought to be different from adults as parents and

carers had a greater influence over children and young people’s opportunities to make choices, access to resources, and attitudes to foods and physical

activities. Thus their behaviours could be better understood within the context of the family model. It was also recognised that the particular age range of children and young people targeted by the campaigns, 13 to 18 years, were

making the transition to adulthood, and thus becoming more independent and making choices by themselves.

Control and autonomy to make choices was associated with purchasing power, i.e. access to financial resources. Children and young people with no or limited

money for their own expenses were considered to be limited in their choices. Whereas those with purchasing power were considered to have choices, but

may not have the relevant information or motivation to make healthy choices.




"Children and young people have purchasing power and buy rubbish breakfast. They seem to buy a lot of fizzy drinks and a lot of them say they do not drink

water." (National Policymaker - patient experience, UK)

5.3 Causes of obesity

Stakeholders were asked about what they thought were the causes of obesity, and how these factors affected children and young people. Their responses are noted below.

5.3.1 Multi-dimensional causes

All stakeholders described the causes of obesity as being multi-dimensional and

an individual’s choices was shaped by multiple factors that influenced their decisions for leading healthier lives. Home, school and community are all thought to shape children and young people’s environments that could either

support or hinder healthy lifestyles. These multi-dimensional factors include:

Poverty Food manufacturing Access to opportunities for exercise

Poor diet, including over-eating and eating unhealthy foods Parental influence

Peer influence Emotional wellbeing Medical conditions

5.3.2 Emotional wellbeing

The emotional wellbeing of individuals, such as unhappiness and anxiety, was considered to be an important factor that could hinder or instigate children and young people to adopt healthier lifestyles. One stakeholder reflected on her own

experience of working with children and young people, and found unhappiness and anxiety to one of the root causes of obesity that influenced how individuals

saw themselves and the kind of lives they wanted to lead. She also described how raising the confidence and motivation were often the first steps for changing emotions and making positive changes.

"Obesity is accompanied by other issues such as unhappiness, anxiety and

worry about a lot of aspects with growing up. I have been working with children and young people for the last 27 years and have seen an increase in mental health issues in the last 3 or 4 years so there is a lot more going on that we do

not understand." (Local Practitioner - youth work, UK)




Other stakeholders thought unhealthy behaviours were driven by emotions, and described how individuals undertook emotional eating, i.e. eating to feel better,

of unhealthy foods with excessive sugar and salt when they felt unhappy or anxious. This behaviour was thought to affect all groups in society, regardless

of demographics such as socio-economic backgrounds.

5.3.3 Modern day lifestyle habits

Modern day lifestyle habits included a combination of eating the wrong types of food and drinks along with limited exercise was thought to be fuelling excessive

weight gain, and as young people become less active they no longer required the energy content of the all foods and drinks they consumed. Other habits, such as the consumption of snacks with excessive sugar or salt outside meal

times and replacement of water with drinks that contain an excessive amount of sugar, were all thought to be the norm in society.

5.3.4 Modern housing and living spaces

Opportunities for regular physical activities were limited by space and places

where children and young people lived. This included, for example, those who live in urban areas with limited access to green places, households with small or no garden, or in communities with a high crime rate – all of which made it

difficult to play or do outside activities. Organised activities were often paid for ones that were too expensive for families on low-incomes, or did not attract the

interest or spark the motivation of children and young people.

5.3.5 Motivation for change: Body image versus health

A few stakeholders shared a perception that young people’s, in particular adolescents, motivation for change was different from adults. Young people

were thought to be more concerned about body image, rather than health and the impact of current behaviours on their long-term health. They were thought to be motivated mostly by the need to look good rather than for improving

health and tackling long-term consequences of unhealthy lifestyles, such as diabetes and cardiovascular conditions which were associated as being health

concerns for adults only. “When they start to grow up and be more adults, they start to get worried more

for health than for physical appearance, but before the birthday 18, nothing of this." (Quality Evaluator for a university, Spain)




5.3.6 Culture

Stakeholders also spoke about culture – perceptions, attitudes and values – and

identified what aspects of culture could ensure healthy lifestyles and what aspects were detrimental for healthy living and thus needed to be changed.

Culture: home cooked meals versus processed foods Stakeholders raised concerns about a change in expectations of food in society

with greater preference for quick, simple and convenient solutions to food, and less attention paid to taking time to think about and prepare foods that are

nutritious. Working parents with limited time or parents with limited cooking skills were examples of modern day culture where daily cooked meals and

packed lunches were no longer the norm in some households. This was seen to have contributed to increased consumption of processed foods with negative consequences to individuals’ health, and limited transfer of valuable cooking

skills to the next generation.

"Eat processed food for speed and convenience and to guarantee that children will eat such food. Cooking food from scratch requires skill, cooking facilities, and motivation, and time, and preference- now can see how powerful

marketing is encouraging people to eat processed food." (Communications professional, UK)

Culture: Attitudes about body weight Stakeholders raised concerns about some cultural attitudes of over-weight

children and young people as being a proxy for good health compared to very slim individuals. As one participant described attitudes of some groups who saw

being "chubby” as a sign of good health – an attitude that needed to be changed.

5.3.7 Poverty and its impact on behaviour and attitudes

Poverty and its prevalence had influenced behaviours when individuals make

decisions based on prices or financial costs rather than factors such as nutrition. Increased poverty in many European countries had led to more families and individuals to seek low-priced foods and may have compromised quality for

‘good value’ deals and foods that make individuals feel fuller for longer. This included the increased consumption of convenient, cheap and widely available

foods, such as bollicao (processed pastry), by school pupils in Spain as a substitute for healthy packed lunches despite a strong traditional culture of a nutritious Mediterranean diet:

"We are the main contributors of the Mediterranean diet, but the problem is

that nowadays the social crisis due to economic reasons makes, for example, that children don’t go always to school with a proper lunch…..at junior high




school, when the mother is supposed to make lunch, we found out that children don’t always bring it. Thus they opt to buy candy and other type of junk food."

(Commercial Manager for a market, Spain)

5.3.8 Parental and peer influence

Children and young people’s attitudes and behaviours are shaped by people in

their households, notably their parents, and their peers, and for many stakeholders parental and peer influences were seen to be strong factors that

shaped children and young people’s choices.

Parental influences

Parents or carers are recognised to have purchasing power and control over what food and drinks were brought and available in the home for their children.

This along with parents’ cooking skills and their attitudes and behaviour concerning food, drink and physical activities – all shape children and young

people’s attitudes and behaviours for foods and drink and the level of physical activities they undertake.

Peer influence: Socialising with peers

It was perceived by a few stakeholders that as children and young people grow

older, peer influence become stronger over the choices they make. Eating unhealthy foods and drinks becomes part of socialising for many young people,

and as they gain greater access to money – how they spend it is often influenced by their peers’ opinions and lifestyles. The lure of poor quality and high calorie food is further heightened when it is easily accessible and cheaper

than good quality foods. A stakeholder in England, for example, mentioned how shops selling fried chicken near schools had encouraged young people to

develop negative habits of spending time together after school eating fried chicken along with consuming drinks with excessive amount of sugar.

Another aspect of socialising that influences the amount of physical activities undertaken by children and young people was the growth in the use of social

media. This was seen to have influenced how children and young people socialise – mostly of it being online – with limited opportunities for face-to-face interaction and activities, and for younger children, play.

5.4 EYTO Campaign Stakeholders were asked about their views and experiences of the campaigns, including approaches used to engage and support peers, what worked well, and the impact on policy and practice so far. Their responses are noted below.




5.4.1 EYTO: Similarities with other projects

Some participants thought that the EYTO project complemented existing national, local and European projects that support healthy lifestyles, in

particular ones that promoted healthy eating and exercise – and used a more inspirational messages and positives images. An example of this from England was the Change4Life social marketing programme - childhood obesity

prevention strategy - launched in 2009.

5.4.2 EYTO: Unique selling point

What made EYTO different from other projects was the youth-led and peer-to-peer approach that placed young people at the centre of project development

and delivery, and in charge of decision-making and direction of the project. It gave young people involved in the project, Campaign Creators, to meet, learn from, and work with professionals for the purpose of shaping project activities

and outcomes.

5.4.3 Project engagement with Campaign Creators

In regards to the recruitment and support of Campaign Creators, experiences of stakeholders varied according to the networks that they had used to recruit

Campaign Creators. The English participants reported that their recruitment was challenging as it was conducted through only one youth centre and a

smaller pool of potential candidates compared to the other partners. Both the Spanish and Czech Republic partners recruited through schools networks with a greater number of children and young people, and thus were able to recruit at a

quicker rate.

All stakeholders mentioned the importance of parental and family support and its impact on Campaign Creators. Families who understood and valued the purpose of the campaign and the role of Campaign Creators were seen to be

better able to provide encouragement and support.

5.4.4 Project engagement with peers – children and young people

One of the key challenges of engaging with children and young people during the project was the term ‘obesity.’ It was not considered to be motivational for campaign audiences to take an interest or see it as being relevant for them due

to reasons such as they may not consider themselves to be obese or embarrassed to admit that they are. This was explained by one stakeholder who

found that the use of positive language and an aspirational approach made a big difference when engaging with children and young people and motivating

them to find out and do more.




"At the start it was difficult because children and young people tend to run

away from issues of obesity - this is why it is important to use the right language and approach when raising awareness of this particular issue.” (Youth

Worker, England) EYTO was seen not only as a reactive strategy that tackles obesity, but was also

a preventative one that promotes healthy lifestyles of all children and young people. This had opened up the campaign to engage with more groups of

children and young people, and not only those who are obese, some stakeholders thought more could have been done to engage but with a greater number of audiences.

“To involve children and young people is always problematic because many

children is fundamentally passive and today they have a lot of things, which attracts them, they are oversaturated." (Psychologist, Czech Republic)

5.4.5 EYTO successes

Youth-led and peer-to-peer support Placing young people at the centre of project development and delivery had

added value to the project as they had a better understanding, compared to adults, of what motivates their peers and how to make information relevant and

of interest. Campaign Creators drew on their own experiences and interests to shape what and how information should be presented and what activities should

be delivered, including having their ideas converted to straplines and images for logos and marketing products.

“EYTO, it’s a great idea that young people transferring knowledge to their peers, and they show them how to eat and what to do to have a healthier life."

(Teacher 2 for a secondary school, Spain)

Starting conversations and changing perceptions

According to stakeholders, obesity was seen to be a difficult or controversial

topic to engage audiences with. One of the successes of the EYTO campaign was that it instigated conversations and thinking about issues related to healthy lifestyles and the challenges of leading one. One stakeholder explained how the

project had changed campaign audiences’ perception of their health being their own rather than someone else’s responsibility, and thus they had the capability

to make changes: "I think one of the ways obesity problem will be solved is by getting everyone

involved with it so public see it as their problem rather than NHS telling them




that they have a problem and they need to do something about it. It needs a national conversation. I think this project shows that's possible and it is one

way of approaching things." (Communications professional, UK)

Involvement of other countries

Stakeholders reported that interaction and discussion between Campaign

Creators and EYTO management teams from different countries brought many benefits, including sharing of ideas, how to overcome challenges, opportunities to reflect on their own progress, and learning from others. It added particular

value to Campaign Creators’ experience as it provided them the opportunity to learn and experience different lifestyle and attitudes to food and living – and

take on ideas for their own Campaign.

Creativity

Creativity was one of the skills used by the Campaign Creators when they developed and delivered a range of fun and interactive activities. It was noted

by stakeholders that Campaign Creators thought of ways to engage and inspire their audiences, such as blind food tasting of healthy food; demonstrations on how to make healthy cupcakes; pop-event at a sports show; lectures; and

quiz/game show on healthy habits. These activities were considered by stakeholders to actively engage with activities rather than be passive in-takers

of information.

Key messages embedded in activities

Key messages about healthy living were embedded in face-to-face events so that audiences could enjoy the activities and remember messages. A Spanish

stakeholder, for example, described how the healthy tapas workshop was a success as it was presented as a fashionable and popular activity with demonstrations on how to make healthy foods.

"They learned how to use the basic products like salt, olive oil, vinegar… Things

that are so simple and so common, but they are not used to use them at meal time." (Teacher 1 for a secondary school, Spain)

Working with professionals

Working with professionals to co-produce reliable and accurate information that is also accessible was described by stakeholders as an asset. The project

supported the transmission of information from professionals to Campaign Creators and then from Campaign Creators to peers. This ensured that technical information, such as nutritional concepts, was shaped and tailored to meet the

needs of peers. English stakeholder, who delivered communications support, described the process undertook by Campaign Creators when they developed

the brand and logo. This included a session delivered by professionals on social




marketing to find out what they liked to do and what communication channels they have used. This was followed by a second session led by a psychologist on

health, healthy living and activities - all of which was visualised through art and brainstorming. Discussions from these sessions helped Campaign Creators to

tell designers about their brand ideas, key messages and images for logo and poster design.

5.4.6 Challenges of the Campaign

Limited time of Campaign Creators

Stakeholders who had supported Campaign Creators with the planning and delivery of activities found that Campaign Creators sometimes did not have enough time to work on their campaigns as they had to balance their school,

social and home commitments.

Engagement of audiences from different backgrounds

Stakeholders found that the campaigns had not engaged with audiences from

more diverse backgrounds. A UK stakeholder, for example, noted that there were more females than males who engaged with the campaign, and a Spanish stakeholder noted that there was scope to involve audiences from different

institutions. Targeting audiences from more diverse backgrounds was thought to bring benefits to groups, in particular ones who would not normally engage

with such campaigns.

Parental influence

Parental influence was considered to be a greater influence than the impact of social marketing, and thus support at home was essential to develop positive

changes in habits and behaviours. If parents purchase unhealthy foods, do not cook, and lead inactive lives – the power of social marketing approaches will not be as effective. A couple of participants suggested that family model approach

should be adopted that ensures parents are reached and able to provide the appropriate environment and support for their children to make healthy choices.

Limited or no follow-up activities

It was mentioned that there were not enough follow-up activities that audiences could participate in following on from the engagement activities or information.

Participation in follow-up activities and services were seen to be important for incentivising behaviour changes in eating and physical activities, as audiences

required resources and opportunities to start making changes in their lives.




One stakeholder explained how messages were not enough to change behaviour, but had to be attached to programme of activities to ensure that the

certain behaviours were being encouraged even after the campaigns had come to an end.

"In the future would like to see greater link between the campaign and signposting young people to actual activities where they will taking exercise. I

think that will make it a lot more successful." (National Policymaker - children, young people and families, UK)

For this approach to be effective, however, the activities and services that audiences follow on from the campaigns had to be appealing so that it motivate

individuals to attend, as well as ideally free and delivered in accessible places and times.

5.5 Social media Stakeholders were asked about how social media was used by the campaigns, and whether they thought it was an effective tool. Their responses are noted

below.

5.5.1 How social media was used

Harnessing the benefits of social media

Stakeholders thought it was important to understand the benefits of social

media and learn how to use it in a positive way for specific purposes, other than for talking with friends and other personal contacts. It was seen as tools for initial engagement and evoking audience’s curiosity and as a channel for

exchanging positive ideas. It described as a creative way of sharing information, and tools for reaching individuals that Campaign Creators would

not normally meet and for interacting with a large numbers of individuals in a short space of time.

Finding appropriate tools

Stakeholders understood the diverse range of tools available and the importance of finding the right ones for specific purposes. One Youth Worker

who worked with UK Campaign Creators explained how different social media tools were tried and tested before it was narrowed down to Facebook and Twitter.




Writing appropriate content

Social media was considered to be channels for sending out messages, but content and messages were seen to be just as important. One participant

described how the professionals working on the campaign with the Campaign Creators ensured that quality information was shared with audiences

"The social tools depend of whom is controlling them. Projects or campaigns as EYTO, has people with a lot of knowledge in nutrition, sport, communication.

The cool thing is that they “taught “our students, and the used the Facebook to transmit what they learned. So behind the young people, there where experts. So in this case it’s very important who is controlling these networks."

(Commercial Manager for a market, Spain)

5.5.2 Benefits and limitations

Modern communication tools Social media was seen as the norm form of communication in modern society

especially among children and young people, and thus something that needed to be harnessed and used.

"Now days, they do not conceive a world without social networks. There are adolescents, that when the day finishes, they have to check all their social

networks. And in some way this media is a channel of communication, a channel to share material. It’s part of their life.” (Commercial Manager for a

market, Spain)

Limitations

Although social media was described on many occasions as being effective, one participant stated that it is not entirely possible to explain its impact and

another mentioned that Campaign Creators had to do their own research to find the most appropriate tools for their campaigns.

Other limitations included challenges of how to encourage online users to use off-line activities and services, and how to encourage off-line users to use

online materials. It was not seen as a replacement for face-to-face communications which was a more personal contact that had greater potential

for changing behaviours, especially if it was face-to-face contact with individuals they could trust.

“Young people use social media to contact each other but it is no replacement for face-to-face communication with trusted adults or young people." (National

Policymaker - children, young people and families, UK)




Participants who supported Campaign Creators to deliver campaigns found social media to be time consuming as it required a lot of time and effort to

manage social networks, think of new ideas and activities, and find different ways to attract online users and to keep them interested. This was seen to be

difficult for Campaign Creators who were in full-time education and had limited time to work on their campaigns.

5.5.3 Tool for tackling obesity and changing behaviours

Social media helped to make the first and initial contact with individuals:

“Make initial connection with young people. EYTO campaign used the Social Media not as a way to inform the kids, but as an encouragement to take them

outside and learn how to tackle obesity.” (Local Policymaker - sport, Portugal)

It was, however, seen to be limited it is capacity to change behaviours that lead to obesity. For some, social media by itself was not seen to be powerful enough to lead to such changes. For others, social media had the potential to lead to

positive changes in behaviours, only if it was used with the aim of achieving specific positive objectives. One example is of UK Campaign Creators who used

social media to set exercise challenges for themselves and monitor their progress online, which was seen to provide audiences with ideas of how take steps towards a more active life. Other observations that suggest attitudes and

behaviours of individuals were changing were of individuals who signed up to social networks, gave positive feedback and asked questions online:

"It is not only about content itself, but calls for doing some action and reaction." (Psychologist, Czech Republic)

5.5.4 How to improve the use of social media in the future

Participants suggested ways to improve how social media could be used in

future campaigns. This included better targeting of parents, in addition to children and young people, as parental influence was considered to be an important aspect of ensuring positive environment at home.

It was also suggested that Campaign Creators required further support and

training on how to use social media effectively, including what tools to use, for what purpose and how.




5.6 Impact Stakeholders were asked about the impact of the campaigns on Campaign Creators, young people who worked on the campaigns, and their peers and other audiences who engaged with the campaigns. They were also asked to talk

about the limitations of the campaigns and whether it had any impact on policy and practice so far.

5.6.1 Impact on Campaign Creators

Knowledge and understanding

Stakeholders reported that Campaign Creators’ knowledge and understanding

of obesity and how to lead and support others to adopt particular healthy habits and behaviours. Working with other countries had added value to Campaign Creators’ understanding of the topic of obesity and about themselves, as they

were able to share experiences with young people from the other four countries and reflect on their own lifestyles and attitudes towards food and physical

activities. One UK Youth Worker, for example, described how after a project exchange meeting with other European partners in Spain, a UK Campaign Creator tried salad for the first time and started to prepare salads at home.

Working with people from other countries had given Campaign Creators more insight and motivation for supporting other young people to do the same and

try new foods and activities.

Skills development

Campaign Creators were seen to have developed a range of skills as a result of working on their campaigns. These included:

Communication skills, such as presentation of information online and face-to-face presentations.

Social media skills, such as development of online materials including video, taking photos and posting them online.

Social marketing skills, such as marketing and branding.

Leadership skills – for driving forward ideas.

One stakeholder described how Campaign Creators had grown in confidence

during the campaigns: "They (Camping Creators) have just blossomed. From meeting them at the

beginning of the programme to seeing them to how they presented in a room full of 40 adults at NCB workshop in March." (National Policymaker - children,

young people and families, UK)




Attitudes and behaviours

A general observation among stakeholders was that Campaign Creators had changed their attitudes about food and physical exercise and had greater desire

to make healthy choices. They noticed that they had become more open to new ideas and different lifestyles that they may not have considered prior to the campaigns. This was seen to have developed their ability to influence and shape

other people’s attitudes, as they were able to decipher technical concepts such as nutrition, gather information and present messages in an accessible way to

peers – including younger and older peers. One stakeholder described how the process of putting together and delivering information and activities to their peers also had an impact on Campaign Creators’ own attitudes and behaviours

as: "by helping others, they help themselves." (Teacher for a primary school Czech Republic)

5.6.2 Changes in behaviours of peers and other audiences who engaged with the campaigns

There were only a few general observations from stakeholders about the impact of the campaigns on peers and other audiences include increased interest for eating healthier foods and doing more physical activities. One local education

policymaker in Spain, for example, found that a school reported reduced purchases of sweets and chocolates on school premises compared to previous

years. Most stakeholders could not describe what and how the behaviours of peers and

other audiences had changed as a result of the campaigns, and ones that provided general observation found it challenging to verify outcomes were as a

result of the campaigns. One stakeholder mentioned that changes in behaviours were challenging to capture due to the short duration of the campaigns. He

explained that campaigns had to be delivered over a longer period of time for changes to take place.

"I’m not sure that they changed habits. The surveys will tell. But at least to create awareness it work perfectly. This kind of projects have to have

continuity… since pre-school until university." (Commercial manager for a market, Spain)

One of the successes of the campaigns was making issues related to healthier lifestyles more relevant for children and young people who may not previously

thought about their health and consequences of negative habits and behaviours. It gave peers practical examples of what they could do to make positive changes in their daily lives:




"I think the campaign showed that even children in elementary school can be active and seek for a change with a broader social significance." (Psychologist,

Czech Republic)

The motivation and enthusiasm of Campaign Creators was considered to be contagious as it encouraged audiences including stakeholders to reflect on their own lifestyle habits and see what improvements could be made. One participant

described how the campaign changed her attitudes: "For me, as someone who helped a bit, I can say that it certainly had a big impact. Children got me with

the enthusiasm, which they went into with and I was a little forced to think about my own lifestyle." (Social Media professional, Czech Republic)

5.6.3 Limitations: Parental influence

Parents were thought to influence children and young people’s opportunities to make choices, access to resources, and attitudes to foods and physical

activities. As explained by one Portuguese participant: "the homes where most of the young people still eat" (Journalist, Portugal). This is linked to earlier

point27 that children and young people’s experiences and choices could be better understood within the context of the family model.

“The key is to influence eating habits in families, not only children” (Teacher for a primary school teacher, Czech Republic).

These campaigns, however, were not designed to targeted parents as well as

their children despite the positive or negative role parental influence could have on the behaviours of their children.

5.6.4 Impact on practice and policy

Many felt that it was too early to see the impact of the campaigns on practices and policies. There were, however, examples of dissemination events delivered

by Campaign Creators and EYTO management teams that have targeted policymakers and practitioners. These include UK Campaign Creators who delivered a presentation for policymakers and practitioners, such as

representatives from Department of Health, Public Health, Youth Forum, voluntary sector organisations, teachers and other professionals. And the

Spanish Campaign Creators who presented to local public authority figures, government officials and institutional representatives at a collaborating university led event on young people and healthy lifestyles.

General observations from stakeholders who have had conversations with

policymakers and practitioners about the EYTO campaigns found that the

27 See 5.2.2




campaigns could add value to existing programmes and policies that support healthy lifestyles and tackle obesity among children and young people, such as

the Rise Above and Change4life health and wellbeing initiatives in the UK. One Portuguese participant mentioned that the campaign had helped them to raise

awareness among policymakers of a new and emerging issue that requires greater attention and action:

“Right now the Health Ministry is finally realising how important these campaigns are and the EYTO project can be a plus for the already existing

projects, most of them, for children or adults." (Communications professional, Portugal)

5.7 Suggestions for practitioners and

policymakers Stakeholders were asked whether they had any suggestions or recommendations for practitioners and policymakers on how the campaigns

could be improved and how permanent changes can be made to obesity rates. Their responses are noted below.

5.7.1 Collaborative working

Holistic and collaborative approach

Tackling obesity among children and young people required a holistic approach whereby all agents – communities, food manufacturing and retail businesses,

schools and colleges, parents and policymakers – must work collaboratively to bring about a wide range of changes to what foods, drinks, places and

opportunities are available and whether individuals have the knowledge and skills to make healthier choices. It was believed that all actors in children and young people’s lives – at school, home and community – could support positive

behaviours and attitudes for healthy living. Thus a joined-up approach was required for addressing the issue, so that an appropriate environment could be

developed that supports health and wellbeing at home, school and in community. "As a market worker, everyone has an important work on how to promote fresh

food, how to transmit the message to all population, how to include the persons. Everything is important." Here at the market we organise a ‘tapa’

(snack) fairy, where each stand prepared their own tapa in a healthy weight. We tried to make it as natural and as healthy as possible.” (Commercial manager for a market, Spain)

Working with food manufacturers Food manufacturers was one of the professionals that stakeholders mentioned

should be involved in a collaborative approach for tackling obesity. Stakeholders




raised concerns about excessive availability of manufactured and processed foods with limited nutrition content, but at low costs and increasingly seem as

alternatives to meals prepared with fresh ingredients. This was seen to be an issue that could be addressed by policymakers so that healthier alternatives,

such as fruit and vegetables, were available at similar low costs and processed foods were not widely available in places such as in or near schools. Other suggestions included clear labelling of foods and drinks to show sugar, salt and

fat content for consumers to make informed decisions. This was seen to be a particular issue for foods and drinks that are marketed and appear to be

nutritious, but are in fact processed and have excessive amount of sugar or salt.

5.7.2 Review and strengthen social media approach

Stakeholders were aware of excessive amount of information being transmitted by social media that it was challenging for EYTO campaigns to compete with existing information and attract the attention of audiences. Thus they

suggested social media should be reviewed to make it more targeted and effective so that information will be accessed and read by more audiences:

“This campaign needed a national approach, for instance through TV, because Facebook and Instagram end up reaching a limited group of people. I think that

the media end up having a double face, because at the same time they ‘sell’ healthy lifestyle, they also ‘sell’ unhealthy lifestyle. They end up promoting

some wrong attitudes and behaviours.” (Coordinator for youth group, Portugal)

5.7.3 Provision of ideas and products

One of the successes of the campaigns was the information and ideas on how

individuals can make small changes in their daily lives. A UK stakeholder, for example, spoke about one aspect of the UK campaign that aimed to increase

fruit intake for breakfast, and the Spanish stakeholder spoke of how the campaign looked at how individuals could incorporate exercise in their everyday lives.

The creation of tangible products by Campaign Creators such as events and

online information provided audiences with ideas and motivation to try new foods, drinks and activities. It was, however, mentioned that this could have been expanded further to include services and activities following on from the

campaign activities.

5.7.4 Review key messages

For some stakeholders to make obesity a pertinent issue was to re-frame key

messages and expand its scope from a campaign about tackling obesity to one




about healthy lifestyle and wellbeing. The term word 'obesity' was thought to have deterred audiences from engaging with the campaign as they may not

consider themselves to be obese or may be embarrassed to associate themselves with such a campaign. Positive and inspirational messages,

however, were preferred as they promoted enjoyment and benefits of healthier lifestyles and more likely to evoke motivation to take action –rather than messages that focus on the negative consequences of obesity.

Messages also had to be targeted at children and young people with appropriate

use of language so that they have a better understanding of how obesity can affect them – including the long-term impact of the current choices.

“All the information that they get is too formal. When they feel something is mandatory they retract, and this is what happen with the young people when

they are lectured about the adoption of a healthier life style.” (Local Policymaker – sport, Portugal)

5.7.5 Targeting vulnerable groups

Better understanding of vulnerable groups

Although a national campaigns were considered to be beneficial, some stakeholders also recognised that vulnerable groups had to be better targeted– i.e. groups that are most likely to have poorer health outcomes and higher risk

of obesity, as these were groups that were often more challenging to engage with and less likely to access campaigns. These groups included communities

with higher incidence of substance misuse and other unhealthy practices, and those with higher prevalence of health conditions such as diabetes and cardiovascular problems. These groups were thought to require a detailed

review and better understanding of how to engage and support them.

Low-income groups

For many stakeholders, individuals’ ability to lead healthy lifestyles was associated with incomes and ability to pay for healthier foods, access to

activities and resources. Those on low incomes were seen to be at a greater risk of leading unhealthy lifestyles that lead to obesity. Appropriate policies were

considered to be ones that addressed the limited resources and opportunities available for low-income groups, which limits their ability to make choices about

what they consume and what activities they have access to.




5.7.6 Developing capacity

Developing capacity of young people to make healthy choices

Stakeholders made many references to developing the capacity – knowledge and skills – of children and young people so that they could make their own choices, and take responsibility for their lives. Self-management of health and

resilience were key attributes that should be fostered in children and young people so that they could make healthy choices despite living in an environment

that is not conducive to healthy lifestyles. Communications professional in the UK, for example, described children and young people as consumers and thought it was important for them to have knowledge about food and skills for

cooking so that they have greater control over what they purchase, prepare and consume.

"Need to invest in children and young people - not just money but time and support. Need to involve and understand children and young people better so

that we can tackle the obesity issue better. They need to be involved, make decisions and be part of the decision-making process. They need to be in it.”

(Communications professional, UK) One suggested approach for capacity development is through education – in

schools and colleges, as one Spanish stakeholder recommended pupils should learn how to lead healthy lives throughout their school years:

“Start in very young ages, primary school, and continue it through high-school,

baccalaureate, and also it could arrive until universities. Use different approaches....It would be interesting that some talks and workshops were implemented in all periods." (Commercial Manager for a market, Spain)

For this approach to be effective, it requires a robust curriculum, trained

teachers and professionals, nutritious school meals, and physical activities embedded as part of the curriculum. Schools were generally seen as a good place to strengthen children and young people’s understanding and knowledge

for making informed decisions.

Developing capacity of parents

Developing the capacity of parents to making healthy choices was considered to be as important as developing capacity of children and young people. This

included providing them with the knowledge and skills to purchase, prepare and cook prepare nutritious meals at home and packed lunches.

Interventions should be delivered with the aim of changing mindsets of both parents and their children so that they think of long-term consequences of

unhealthy diets and lack of exercise on their bodies, future health and financial expenses.




"Appreciating that the reward later will be larger. Teach children to greater

vision for the future and postpone a reward later on. It is actually the most important part of education, which the virtual reality makes difficult.”

(Psychologist, Czech Republic)

School and community approach

Upskilling professionals in schools and other community settings where children and young people have regular contact with were considered to be crucial as

professionals based in these settings have the potential to transmit positive messages on how to lead healthy lives. These professionals could ensure the availability of healthy foods on premises, provision of physical activities, lessons

or activities on health – all of which could provide a supportive environment for children and young people to develop healthy behaviours.

5.7.7 Information provision

Provision of reliable and relevant information

Provision of reliable and relevant information could develop the capacity of

children and young people to make healthy choices. "Need to be read themselves and need to have more info and need to take part

in projects so they can make the right choices. It is important that they are making choices themselves and choices are not being made for them." (Local

Practitioner – health, UK)

Excessive information, however, was considered to be a challenge as children and young people would find it difficult to decipher what is reliable:

“Sometimes children are over-informed and they don´t know, what´s true, little discussion on this topic in the family and at school.” (Social media professional,

Czech Republic) Provision of information from trustworthy sources was considered more likely to

be accepted as being reliable. Participants stressed the importance of the information giver building relationships based on trust so that information leads

to action. Apart from reliability, participants placed emphasis on the provision of relevant

information that could be applied in the everyday lives of individuals. To make information relevant – it was suggested that it should be broken down in to

accessible parts, decipher medical or technical concepts, and include practical examples and guidance on how to make changes in their daily lives. One stakeholder who worked with the Campaign Creators described how an

explanation of obesity measurement, body measurement index (BMI), gave




project participants a better understanding of the measure and impact of obesity on the body– all of which shaped how information was presented to

other young people.

"Mostly when you talk to young people they have understood the basics of it but how this translates to everyday life and things like whether skipping breakfast is going to make you slimmer or if exercise will make a difference to

your weight” (Youth worker, UK)

Information that is both reliable and relevant is thought to bring long-term improvements to health, and was hoped to counteract the current trend among young people to take on drastic diets that bring dramatic weight loss in a short

period of time with limited long-term gains to health.

Sources of information

Stakeholders talked about who is best placed to provide information for children and young people. This included parents, schools or both. Parents were seen as

the catalyst for change as they had the potential to provide a more supportive environment at home that could foster appropriate attitudes and behaviours

from birth.

The education sector was also considered to have great potential for motivating their pupils to develop life skills and behaviours through a robust curriculum and with trained teaching staff to deliver reliable and relevant information

needed to make healthy choices. Some participants felt that schools already played a strong role in supporting positive health behaviours and attitudes.

Others felt that the role of schools could be strengthened and the value of good health on academic achievement could be promoted more widely which could counteract any misperceptions, such as ones among some parents who think

children who spend time playing sports were compromising their academic achievement.

Role models in the community and at home were seen to be living examples of how to lead healthy lifestyles who could talk about the benefits of it and inspire

children and young people to adopt positive habits and behaviours. Concerns were raised about professionals in information-giving roles who were obese,

such as those in health sector, as not being appropriate for such roles.

5.7.8 Availability and opportunities for healthy choices

Some stakeholders raised concerns about the excessive availability of unhealthy

foods in many places and the limited nutritious alternatives. This coupled with limited opportunities for physical activities that are fun, appealing, free and specifically targeted at children and young people – all have made it difficult to

provide children and young people with options for changing their behaviours.




Encouraging more physical activities, for example was considered to be a challenge for variety of reasons, including limited space or limited free

activities.

Another explanation for the low take up of healthier alternatives is that they are not widely promoted or appealing enough for individuals to take up the offers. A stakeholder in Czech Republic, for example, mentioned that there are

opportunities for bike rides, swimming and free playgrounds, and stakeholders in other countries mentioned that healthy foods are available. However, these

options may not be chosen by individuals for reasons such as they may not know them or may not have the time or skills to prepare healthy meals.

Participants suggested more needs to be done to ensure the provision of accessible, free and appealing activities that will motivate children and young

people to participate in physical activities. This coupled with low-cost, widely available and appealing healthy foods and drinks will encourage children and young people to choose healthier alternatives.

5.7.9 Role of policymakers

All stakeholders mentioned that policy-makers understood obesity and its impact on society. However, there were differences of opinions about whether and how much of a role policymakers should have on addressing this issue.

Some felt that it was not a priority, some stated that it was complex issue that policymakers are finding difficult to address despite their efforts, and one

thought it was not the responsibility of policymakers to address such an issue which required a more community-based approach that worked with and developed the capacity of individuals to make healthy choices.

"There is certainly awareness at policy level but it is practically on the ground

how we address these challenges that we are often all struggling with and certainly in terms of evidence base of what has the greatest impact in actually working with and seeing significant results for young people and their families

generally." (Local Policymaker – health, UK)

Most participants were aware that policy changes on its own could not resolve the issue of obesity due to the following limitations:

Conflicting political and economic interests, as policymakers legislate and work with food manufacturers of unhealthy foods and food retailers who are also employers and contributors to the national economy. This often

makes it difficult to restrict their activities. Limited understanding of the challenges facing children and young people.

One participant expressed concerns that policymakers did not fully understand these challenges and had not interacted with children and young people in a meaningful way to find out more.




Greater political gains associated with meeting immediate needs rather preventative measures.


This section included the experiences and views of stakeholders on their

understanding of obesity, how social marketing was used to tackle obesity, and suggestions for taking forward findings. It also included summary of finding from the focus group with EYTO management team across the four countries

that featured in the interim report. A summary of key findings from the interviews with stakeholders as part of the final evaluation are included below.

Summary box

Obesity and its causes

According to stakeholders, causes of obesity are multi-dimensional and

require a joined-up and collaborative approach between professionals in different sectors and parents at home. A few examples of these include

poverty, modern day lifestyle habits, and emotional wellbeing.

The type of risk experienced by children and young people were thought to

be different from adults as parents had greater influence over children and young people’s opportunities to make choices, access to resources, and attitudes to foods and physical activities. Thus their experiences could be

better understood within the context of the family model.

The campaigns were particularly targeted at children and young people

aged 13 to 18, as they were becoming more independent and making choices by themselves and thus required support with making healthy choices.

EYTO campaigns

Stakeholders reported that campaigns added-value to existing initiatives

that promoted health and wellbeing in each of the four countries.

The youth-led and peer-to-peer approach was unique and brought many benefits to the way information and activities were developed and

delivered, and the way in which peers had engaged with the campaigns.

The challenges faced by Campaign Creators included the limited time

frame to plan and deliver activities, and no or limited follow-up activities that audiences can access after their engagement with campaign activities.

Social media




Stakeholders said that social media could be an effective way of communicating with children and young people, but only if it is used with a specific purpose in mind and with appropriate content.

Social media was ideal for initial engagement and evoking audience’s

curiosity, and as a channel for positive exchange of ideas and for

interaction. However, social media was not considered to be a replacement for face-to-face interactions.

Impact

Stakeholders reported that Campaign Creators developed knowledge and a

range of skills that enabled them to plan and deliver activities and

information for their audiences.

Children and young people’s choices for making behaviours changes were shaped by factors such as parental influence. This is linked to earlier point

about the type of risk was seen to be different from adults and their experiences had to be understood within the context of the family model.

Stakeholders reported that it was too early to see the impact of the EYTO

project on changes in practice, but campaigns had the potential of adding value to existing programmes and policies that support healthy lifestyles

and tackle obesity among children and young people.

The next section (Section 6) will summarise key issues identified from the findings and draw together suggestions and recommendations made by

Campaign Creators and stakeholders.




6. Conclusions and recommendations

This section draws together the findings from the report to see how far the

initial EYTO project objectives were met, successes, and challenges of the

campaigns. It also brings together suggestions made by the Campaign Creators

and stakeholders on how the campaigns could be improved for the purpose of

tackling obesity among children and young people, and the challenges of doing

so.

6.1 Conclusions

6.1.1 Achievements

A youth-led and peer-to-peer approach was a valuable aspect of the campaigns

as it placed young people at the centre of the campaigns and gave them greater control over what information is produced and how it was

communicated to peers i.e. children and young people. This brought many benefits, including:

Campaign Creators, with the support of professionals, were able to ensure the provision of reliable, relevant and accessible information. They gathered information from various sources, reviewed it and medical terms deciphered

so that it could be understood and applied in the everyday lives of peers. This process ensured information was shaped and re-reproduced for children

and young people.

The capabilities of Campaign Creators were tapped into and developed, which helped to ensure that they had the confidence and skills to work on

the campaigns, and were better prepared to make decisions and lead on activities.

The campaigns raised awareness of obesity and increased motivation to address unhealthy lifestyles among children and young people and a range of stakeholders. The campaigns placed the issue in to context and it made it

relevant for their audiences in each of the participating countries and cultures. This helped to ensure effective messages were developed and sent

for audiences.

The campaign activities provided audiences with experiences or encouraged audiences to experience changes that are different from their daily habits.

This included the provision of activities, such as taster sessions, opportunity to try sports, setting online exercise challenges, which gave audiences

opportunities to try something different and make changes in their lifestyles.




6.1.2 Other achievements: Initial project objectives

The findings from the evaluation suggest that the campaigns have worked

towards achieving the initial three objectives28 as outlined below:

During focus groups, Campaign Creators reported that they had developed a

board range of skills and increased confidence to apply these skills as a

result of opportunities to complete activities on the campaigns that they

would not normally do in their daily lives.

During interviews, stakeholders talked about how their involvement in the

campaigns had shaped their understanding of the topic of obesity among

children and young people and had identified the challenges of tackling it at

local and national levels. Few of them reported that they had reflected on

their own lifestyles to see how to lead healthier lifestyles and what they

could more of to promote healthy living for communities they work with and

for.

The survey findings showed that of the 237 respondents, most (208 or 87%)

reported that the campaigns were either very effective or somewhat

effective at improving motivation to eat a more healthy diet and be more

physically active, and most (89.9%) reported that the campaigns were

either very effective or somewhat effective at encouraging young people to

eat a more healthy diet and be more physically active.

6.1.3 Challenges

One of the key challenges identified by the evaluation was the limited recording

and reporting of impact on the behaviours of children and young people who

engaged with the campaigns. Whilst there was some evidence from analysis,

and observations made by Campaign Creators and stakeholders – analysis also

highlighted that Campaign Creators undertook limited recording and reporting

of changed behaviours and increased motivation, and how the campaigns had

28 Initial project objectives:

1. Campaign Creators, i.e. young people who delivered the campaign, and professionals

who supported Campaign Creators across the four partnerships will have increased

skills and confidence in applying participatory social marketing techniques.

2. At least 80 per cent of young people who engage in campaigns will have increased

their motivation to eat more healthily and be more physically active.

3. At least 60 per cent of young people who engage in campaigns will have increased

their levels of physical activity and fruit and vegetable consumption.




helped audiences make such changes, including increased levels of physical

activity and fruit and vegetable consumption.

The objective to change behaviours was not considered to be a realistic for

some Campaign Creators and stakeholders. They saw the campaigns as an

effective approach to inform, raise awareness, encourage discussion, and

change attitudes – all of which was believed to instigate and motivate changes

in behaviours. They, however, thought that campaigns by themselves could not

change behaviours of children and young people and other audiences.

Behaviour can be described to be the product of interaction between

motivation, a psychological state, and constraints that include availability of

time and resources29. Campaign Creators and stakeholders also found

motivation to be an important aspect of changing behaviours and identified a

range of constraints associated with:

Limited accessible resources and opportunities

Limited moral support or guidance from parents, friends or peers, and

practitioners such as school staff

Limited information and ideas on how to lead healthy lives.

Motivation, knowledge, skills, resources, opportunities and moral support –

these were all thought to shape children and young people’s agency for making

healthy choices and choosing healthy behaviours.

Provision of support had to be accessible so that would meet the diverse needs

of children and young people and address diverse constraints faced by

particular groups or individuals in society who are likely to experience greater

healthy inequalities, such as those living in low-income households or

individuals with disabilities.

The multi-dimensional causes of obesity was thought to require a collaborative

and cross-disciplinary approach between different professionals and parents so

that they could deliver more and appropriate support and resources, and

complement the work of the campaigns.

6.2 Recommendations

29 Le Grand, J. (2003) Motivation, Agency, and Public Policy of Knights and Knaves,

Pawns and Queen. Oxford University Press




Findings from the focus group with the Campaign Creators, interviews with

stakeholders and survey with peers and other audiences have helped to identify

the following recommendations for practitioners and policymakers. Some of

these are more practical and others are more strategic recommendations, but

all of them interlink with each other and support the development of holistic

and collaborative approaches for tackling obesity among children and young

people.

6.2.1 Youth-led and peer-to-peer approach

The campaigns demonstrated that youth-led approach that placed young people

at the centre of planning and delivery of the campaigns ensured that

information and activities were accessible and appealing for their peers. It was

considered to be an effective way of engaging with children and young people,

and its benefits have been highlighted in this report. More similar approaches

should be delivered where young people are at the centre and lead future

projects and campaigns for their peers.

6.2.2 Provision of relevant and reliable information

One of the strengths of the campaigns was the provision of reliable and relevant

information that was produced by Campaign Creators, for other children and

young people, with the support of professionals. This showed that the pre-

existing information was not as user-friendly for children and young people or

as effective as information that had been shaped and re-produced by young

people so that it could be understood and applied in the daily lives of their

peers.

6.2.3 Family model approach: Capacity building of parents

Parents were thought to have strong influence on their children’s behaviours,

attitudes and access to resources, in particular of younger children. Thus

interventions that develop children and young people’s capacity should be

accompanied by ones that support their parents and carers so that they have

similar knowledge, understanding and motivation for making positive changes

and creating an environment that is conducive for healthy living.

6.2.4 Positive and inspirational key messages

Respondents – both Campaign Creators and stakeholders –mentioned the

importance of promoting positive and aspirational messages along with

promoting positive impact of making changes in lifestyle behaviours. These

should have an emotional connection and motivate children and young people

to read, participate, reflect on their own lifestyles, and take action.




Closely linked to this point, is the suggestion to change the terminology from

obesity to one that is more generic and positive, and one that focuses more on

healthy living. The term obesity was considered to deter individuals from

interacting with the campaigns as some may be embarrassed to associate

themselves with that term and others may not consider themselves to be

obese. The campaigns were considered to be interventions for the prevention of

negative health outcomes associated with unhealthy behaviours – and not only

about looking slimmer. They aimed to promote the wider benefits of healthy

lifestyles and future healthy implications of present unhealthy behaviours.

Most initiatives that tackle obesity are targeted at either young children, in

particular early years, or adults. The EYTO campaigns were thus developed to

inform and embed healthy behaviours in children and young people before they

reached adulthood. This was a particular cohort who were growing older and

starting to make more decisions by themselves – and thus would benefit from

positive and aspirational messages on healthy lifestyles to help them make

healthy choices.

6.2.5 Provision of accessible options for healthy choices

‘Healthy choices’ were mentioned frequently in particular by stakeholders

during interviews. Choices require options of a range of accessible resources

and support. This could include physical activities and healthy foods that can be

purchased within limited budgets. Accessible options need to be made available

that meet the needs and interests of individuals.

6.2.6 Effective targeting of vulnerable groups

Closely linked to the recommendation on provision of accessible options for

healthy choices, above, is importance of ensuring that campaign activities are

targeted at particular groups who are at a greater risk of experiencing obesity

but are less likely to engage with campaign activities, such as those living in

low-income households. Although the campaigns should be open to everyone,

there are particular groups in society that are more vulnerable to obesity and

poor health outcomes, and may require more targeted engagement and

interventions strategies.

6.2.7 Holistic and collaborative approach

Campaign Creators, peers and stakeholders all identified a range of factors that

contribute to obesity and unhealthy lifestyles among children and young people.

Addressing factors required a holistic and collaborative approach between

professionals, parents and carers to ensure that children and young people had

the knowledge, understanding, resources and opportunities to make healthy

decisions for themselves. Suggestions have included: working with food

manufactures; developing the capacity of parents; working with schools to




ensure provision of healthy lunches, physical activities and curriculum that

supported health-related subjects; and encouraging policymakers to develop

policies that support more physical activities and consumption of healthy food

and drinks.

6.2.8 Robust and standardised recording tools

With the exception of attendee numbers at events and a few observations about

profile of audiences and changes in their behaviours and attitudes reported by

- there was limited recording and reporting of impact, in particular, what and

how behaviours have been changed as a result of the campaigns and what

groups had benefited the most from the activities.

More robust impact recording tools and approaches would have helped to

identify and evaluate the most effective tools for engaging children and young

people with and the campaigns’ overall impact on audiences’ behaviours and

how they have benefited or learned from the campaigns. This would help to

shape policy and practice for similar future projects or approaches.

Standardised data collection practices are required to ensure that the data used

for monitoring and evaluation purposes are reliable and comparable across

settings and over time. It should ideally capture both quantitative and

qualitative data to see how behaviours and habits have been changed and

challenges of doing so. Data should also be captured on the dimensions of

inequality, such as socio-economic background and disability to help identify

whether particular vulnerable groups have been able to access the campaigns.

The evaluation methodology devised by NCB’s Research Centre represents a

sound approach to evaluating the project within the confines of available

resources. This evaluation report has drawn upon the findings gathered using

the methodology agreed in NCB Research Centre’s evaluation strategy for the

project. Partners were able to extend the scope of the evaluation where there

was a desire to collect more scientific data about the impact of the campaigns.

The Spanish team recruited a control group of young people and used validated

tools and methodologies, including the Health Behaviour in School-Aged

Children surveys, to record and evaluate the effectiveness of their campaign.

Findings from the Spanish specific evaluation have not been included in this

report.

Final conclusions

EYTO campaigns worked towards initial objectives of increased understanding

and motivation for healthy eating and undertaking physical activities.




Key aspects of the campaigns that made it effective in engaging with and supporting children and young people on the topic of obesity were:

A youth-led and peer-to-peer approach that placed young people at the

centre of the campaigns and gave them greater control over the provision of reliable, relevant and accessible information.

Capabilities development of Campaign Creators so that they were better

prepared to make decisions and lead on activities.

Raised awareness of obesity and increased motivation to address

unhealthy lifestyles among children and young people and a range of stakeholders.

Provided experiences or encouraged audiences to experience changes that

are different from their daily habits.

However, the use of campaigns alone may not bring about changes in

behaviours, in particular long-term sustainable changes. These changes require increased collaborative working with parents and professionals in the

community and from different sectors to ensure children and young people have accessible and available options to make healthy choices.


Interim summary of learning

EYTO is a peer-led social marketing project working in four European countries to promote healthy eating

and physical activity and stem the rise in obesity among adolescents. The National Children’s Bureau (NCB)

leads the partnership with organisations in Spain, Portugal and the Czech Republic.

The project has four core elements:

Reviewing effective social marketing interventions to promote healthy lifestyles.

Recruiting groups of disadvantaged young people (Campaign Creators) to research, design and launch

new social marketing campaigns across their local communities to promote healthy lifestyles amongst

their peers.

Providing support to the young people across the partnership to share learning and ideas.

Promoting cross cultural campaign messages, associated tools and resources across Europe.

The NCB Research Centre is leading the evaluation of the project; evaluating the impact of the campaign on

outcomes for young people and those working to support them. This briefing presents an interim summary

of learning.

Perceptions of obesity among young people:

The interim evaluation included an online survey of 139 young people, across the four partner countries,

who had engaged with the EYTO campaigns. The survey data highlights that young people perceive obesity to

be a complex issue – determined by a range of internal and external factors.

Overwhelmingly young people identified internal, emotional factors as the main barrier to making healthy

lifestyle choices; choosing lack of motivation and will power, as well as lack of enjoyment of exercise as the

top three challenges. Young people thought that more support from parents and greater access to activities

would help them to live healthier lives; alongside internal factors of enjoying healthy eating and caring about

how you look. The young people responding to the survey also identified primarily internal factors as the

causes of obesity.

These views echo those of the young Campaign Creators working on the project. Across all partner nations,

young people overwhelmingly express that messaging to tackle the issues of overweight and obesity with

their peers needs to be grounded in how young people feel about themselves and their lives. Early

indications are that addressing self-confidence, resilience and life skills may be an effective route to

empowering young people to make healthy lifestyle choices.

“I have always thought about healthy lifestyles only in one way – how to lose weight. Now I see that it’s

more complex. It’s also about your motivation, about your emotions and your whole life”. EYTO Young

Campaign Creator

The power of social marketing approaches:

Overall, the majority of young people responding to the surveys (88 percent) felt that the EYTO campaigns

were effective in encouraging young people to eat a more healthy diet and be more physically active. 83 per

cent of respondents felt that the campaigns had been effective in both motivating and showing young

people how to eat more healthily and be more physically active. 90 per cent of respondents felt that the

campaigns were effective in communicating why this is important.

Young people responding to the surveys found the EYTO campaigns to be effective in improving motivation:

96 per cent overall had discussed the campaign; thought about making a change to their lifestyle, or tried to

find out more about living healthily. However, just 17 per cent have made a change to their behaviour in

terms of eating or exercise habits. This finding may be accounted for by the fact that the survey data was

gathered during the early stages of the campaigns. The EYTO project team will continue to monitor ongoing

self-reported responses from young people about making real change to their behaviours over the remainder

of the project.

The young Campaign Creators involved in leading the project have increased confidence and skills to engage

with communication and social marketing activities, as well as an appreciation of learning about social media

as a route to achieving serious objectives. Early outcomes for these young people also include increased

awareness and understanding of the issues, motivation and ideas for leading a healthy lifestyle, and

encouraging others to do so.

“It’s a problem in everyone’s country...and I hadn’t realised that before.” EYTO Young Campaign Creator

Supporting successful youth-led work:

From the experience of managing EYTO, project partners - through the interim evaluation process - identified

a number of aspects that support successful youth led social marketing work. These include; developing a

bespoke approach to involving young people; taking timing and context into account when recruiting young

people; ensuring that content creation is actively managed; bringing people together; and balancing youth-

led approaches with the need to achieve project outcomes.

The EYTO project has developed a youth-led approach to using social marketing techniques to address

lifestyle issues with adolescents. The model has young people’s participation and co-production at its heart,

which has ensured the work is engaging and relevant for their peers. It has also taken an ecological approach

– promoting good nutrition and physical activity within the contexts and environments of young people’s

lives as whole: where they live, study, work and hang out. By supporting the young people to take creative

control, grounding the work in their lives and showing them how they’re influencing their peers; young

people involved in the approach have developed new skills and confidence. The model is also developing a

more coordinated approach to tackle obesity at a local level.

“At the beginning of the project, we were shy, and now we know how to talk and communicate with

others.” EYTO Young Campaign Creator

The final findings from the EYTO project will be published by the end of 2015.

Pivotal insight: Young People in the

EYTO project

Highlights

● We must include young people as proactive agents in health promotion.

● Youth can contribute to health interventions, such as the improvement of healthy habits, when they have enough information, support and motivation.

● Young people can easily identify the main barriers and strengths of health promotion initiatives.

● Peer-led and social marketing have been effective in health promotion interventions with adolescents.

What is EYTO?

European Youth Tackling Obesity (EYTO) was a youth-led and peer-to-peer project that used social marketing campaigns to tackle obesity among young people (13 to 18 years old) living in disadvantaged communities in four European Countries (United Kingdom, Spain, Portugal and Czech Republic). Since obesity rates follow a social gradient in which the highest rates are present in racial/ethnic minorities and poor populations1, actions with innovative and effective approaches are needed to prevent this health issue are needed in this populations.

The main project objectives were to increase skills and confidence in applying participatory social marketing techniques with adolescents; as well as engaging young people in campaigns created by peers to increase their motivation to eat more healthily and be more physically active, with the intention for a long-term obesity prevention.

What makes it different?

This project emerged from the social need of a more collaborative strategy that gives young people a leading role in addressing health matters affecting them (such as obesity). The campaigns were created across Europe by adolescents for adolescents in disadvantaged neighborhoods by Campaign Creators (the young people who were involved in the campaign delivery).

Although in the EYTO project each campaign was tailored for audiences in their own countries, different and innovative approaches had the following in common: youth-led methodology, placing young people at the center of the project, social marketing approach and peer-led strategies as methodological bases to support good practice in obesity prevention. The use of social networks as a communication tool and a health promotion channel with young people was also a singular approach. Including young people, researchers, stakeholders and policy makers was essential for creating a movement that addressed obesity prevention in the public health strategies of local areas.

Prepared by Magaly Aceves-Martins, Universitat Rovira i Virgili and Aixa Y Alemán-Díaz, WHO Collaborative Centre for International Child and

Adolescent Health Policy at the University of St Andrews.

Why are young people pivotal?

Adolescents represent a healthcare challenge, due to the transition process of parent-managed care to

personal decision-making. In addition, adolescents experience a physiologic and cognitive transition,

where they try to reshape their identity and establish relationships with their social environment. The

adolescent period is crucial in determining longer-term obesity risks and provides different opportunities

to develop healthier lifestyles2. The EYTO project made young people a central partner in this obesity

prevention challenge.

In adolescence, peers can be a deciding factor in the youth's decision making process, including an

important influence on health related behaviors through their attitudes, and also the different

information sources accessible to them. The EYTO project showed how viable and effective this type of

intervention can be especially to prevent health issues in young disadvantaged populations, and

underscored the need to integrate them in the general efforts for improving wellbeing in their

communities. The created campaigns worked towards initial objectives of increased understanding and

motivation for healthy eating and undertaking physical activities. These changes require increased

collaborative working with parents and professionals in the community and from different sectors to

ensure children and young people have accessible and available options to make healthy choices.

EYTO Contact information:

Website: www.eyto.org.uk

Amy Davies

Senior Development Officer –

Health & Social Care

National Children's Bureau

8 Wakley Street | London | EC1V 7QE

Tel: 07850 926988

Email: [email protected]

Rosa Solà M.D.; PhD

Health Education and Promotion Research Group

Functional Nutrition, Oxidation and

Cardiovascular Disease Research Group

Medicine and Surgery Department

Universitat Rovira i Virgili

C/ Sant Llorenç, 21, 43201

Reus, Spain.

Tel: (+34) 977 759345.

Email: [email protected]

References: 1.-McLaren L: Socioeconomic status and obesity. Epidemiol Rev 2007, 29:29-48

2.- Srof BJ, Velsor-Friedrich B. Health promotion in adolescents: a review of Pender's health promotion model. Nurs Sci Q. 2006

Oct;19(4):366-73.

http://www.eyto.org.uk/

What made EYTO effective in engaging with and supporting children and young people on the topic of obesity? Youth-led and peer to peer approach gave young people greater control top provide reliable, relevant and accessible information. Capabilities development of young volunteers so that they were better prepared to make decisions and take the lead. Raised awareness of obesity and increased motivation for healthy eating and undertaking physical activities. Provided experiences different from audiences habits.

Long term sustainable changes to behaviour, requires multi-disciplinary collaborative working with young people, parents and professionals in the community through: Positive and inspirational messaging and provision of relevant and reliable information; Provision of accessible options for making healthy choices Effective targeting of vulnerable groups A youth-led and peer-to-peer approach, which adopts a holistic method A family model approach, building the capacity of parents Use of robust and standardised recording tools.

Further information: The project was led by the UK based National Children’s Bureau (NCB) in partnership with; the CTNS Technology Centre of Nutrition and Health in Spain; Komunikujeme in the Czech Republic; and Companhia de Ideas in Portugal; and was made possible by funding from the

European Union Executive Agency for Health and Consumers in the framework of the Health Programme 2008-2013.

Amy Davies, Katie Rix & Evangeline Amalathas

National Children’s Bureau WWW. EYTO.CO.UK / [email protected]

A YOUTH LED SOCIAL MARKETING APPROACH TO ENCOURAGE HEALTHY

LIFESTYLES

Research has shown that 22 million children in the EU are overweight or obese It is a significant public health challenge and health inequality for all countries represented in the EYTO partnership affecting one in three children in the UK, half of children and young people in Portugal and Spain and a third in the Czech Republic. (World Obesity Federation, 2013). Young people from low income groups are particularly at risk (Reilly, 2009). The teenage years provide a vital window of opportunity however there is a lack of targeted approaches to tackle the complex issues that adolescents face. Whilst youth-led social marketing campaigns have been successfully developed on other health topics, the potential to use this technique to tackle obesity has yet to be realised. Therefore, EYTO was designed to support groups of 13-18 year olds living in disadvantaged communities across Europe to research, design and launch new social marketing campaigns to promote healthy eating and physical activity amongst their peers. The project provided support to young people across the partnership to connect with one another, promoting cross cultural learning, and the development of tools and resources to replicate the EYTO approach.

Background

The EYTO project method

Key evaluation findings and discussion

The EYTO project was led by National Children Bureau’s (NCB) Health and Social Care team in the UK, and delivered in partnership with three other organisations in Spain, Portugal and the Czech Republic. EYTO consisted of the following aspects: Reviewing learning from effective social marketing interventions to tackle childhood and youth obesity. Recruiting and supporting a network of young volunteers or ‘Campaign Creators’ across the participating

countries to develop social marketing campaigns in a range of settings within their local communities to promote healthy lifestyles amongst their peers vulnerable to obesity.

Providing support to the young people across the partnership to share learning and ideas Promoting cross cultural learning, campaign messages, and associated resources across Europe

I have always thought about healthy lifestyles

only in one way – how to lose weight. Now I see

that it’s more complex. It’s also about your motivation, about your emotions and your

whole life.

EYTO Young Campaign Creator

Evaluation methodology An evaluation of the EYTO project was run by the NCB Research Centre, across the four participating countries, throughout the project which ran from 2013-15. The methodology used in the final evaluation is depicted below in Table 1. This methodology was used to assess how far healthy eating and physical activity was promoted amongst children and young people.

Table 1: Evaluation methodology

EYTO Project Method N

Campaign Creators Focus groups and activities Total 12 focus groups (3 in each country)

Stakeholders Interviews 22

Young people engaging with the project Survey 237

Activity monitoring Analysis of activities

It’s definitely more effective if something is told

by your peer, rather than from

somebody older...because

your peer understands you

the most. EYTO Young Campaign Creator

CAMPAIGN CREATORS FOCUS GROUPS

Positive and inspirational messages promote healthy lifestyles.

Developed skills, knowledge and confidence.

Positive emotions and motivation change behaviour.

STAKEHOLDER INTERVIEWS Youth-led approach helped to shape the provision of relevant and accessible information.

To make healthy choices children and young people require accessible choices.

Obesity can only be addressed through collaborative and holistic approaches.

SURVEY Causes of obesity associated with eating (48.6%) and not enough physical activities (33%).

89.9% of respondents rated campaigns as somewhat or very effective in encouraging them to eat a healthier diet and be more active.

ACTIVITIES 9,503 individuals engaged with paper-based activities.

4,336 individuals engaged with face to face events.

2,984 individuals engaged with web-based activities.

16,823 young people engaged in total across 4 countries.

https://www.dropbox.com/home/EYTO/EYTO - Photographs?preview=file000549.jpg



Evaluation of European Youth Tackling

Obesity project

Interim evaluation report – February 2015

Eliza Buckley, Vanessa Greene, Joanna Lea

National Children’s Bureau: working with children, for children

Registered Charity Number 258825.

8 Wakley Street, London EC1V 7QE. Tel: 020 7843 6000 Connect with us: Facebook: www.facebook.com/ncbfb Twitter: @ncbtweets

© NCB, February 2015

http://www.facebook.com/ncbfb

EYTO interim evaluation report

2

Contents

1. Introduction.................................................................................... 3

1.1 European Youth Tackling Obesity (EYTO) ..................................... 3

1.2 Evaluation of EYTO ................................................................... 3

1.3 Evaluation methodology ............................................................ 3

1.3 Structure of the report .............................................................. 4

2. Findings ....................................................................................... 5

2.1 Partners - planning and management of EYTO .............................. 5

2.2 Campaign creators .................................................................... 8

2.3 Wider impact – a snapshot survey ............................................. 13

3. Conclusion .................................................................................. 24

Appendix 1: Internal/external survey codes ....................................... 25

Appendix 2: Country tables ............................................................. 27


3

1. Introduction

1.1 European Youth Tackling Obesity (EYTO)

EYTO is a peer-led social marketing project working in four European countries

to promote healthy eating and physical activity and stem the rise in obesity among young people.

NCB’s Health and Social Care team lead the partnership with organisations in Spain, Portugal and the Czech Republic.

The project has four core activities:

A review of effective social marketing and healthy lifestyle interventions Recruitment of groups of disadvantaged young people to lead the

development of new campaigns Provision of support to the young people to research, create and pilot the

campaigns

Development of webpages to promote campaign messages across Europe.

1.2 Evaluation of EYTO

The NCB Research Centre is leading the evaluation of the EYTO project. The

overall aims of the evaluation are to:

Provide an initial evaluation of the project start up and progress achieved

towards its objectives in the first year Gather feedback from campaign creators, campaign participants,

stakeholders and partners to explore if and how the project meets its

objectives, and what process and impact outcomes are achieved.

The objectives are to evaluate the impact of the campaigns against the

expected process and outcome indicators. We will focus on the project’s achievement of the outcome indicators for young people, which are as follows:

Young people and practitioners across the four partnerships have

increased skills and confidence in applying participatory social marketing techniques.

At least 80 per cent of young people who engage in the campaign report increased motivation to eat more healthily and be more physically active.

At least 60 per cent of young people engaging with the campaign report

increased levels of physical activity and fruit and vegetable consumption.

1.3 Evaluation methodology

The evaluation is using a combination of quantitative and qualitative methods to

achieve the objectives outlined above:

A focus group with partners to review learning from the set-up phase


4

Three focus groups with campaign creators in each country at baseline; mid-point and end of campaign to collect evidence on: motivation to

participate; views on the causes of obesity and the barriers/enablers to healthy living; skills, confidence and knowledge of participatory social

marketing campaigns

An online survey of campaign participants to gather data on campaign awareness, effectiveness and impact, as views on causes of obesity and

enablers/barriers to healthy lifestyles

Telephone interviews with five campaign stakeholders in each country to

understand effectiveness of the campaigns, use of social marketing as a tool for addressing obesity, fit with the wider context of health development work

Assessment of the reach and outcomes of campaign activities via an ‘impact tracker’.

In February 2015, the following activities had been carried out and form the

basis for this report:

Partner focus group

Baseline and mid-point focus groups with campaign creators in each country

Online survey of campaign participants (launched November 2014 and ongoing. Data reported here was gathered between November 2014 and

January 2015)

1.3 Structure of the report

This report outlines interim findings from the evaluation. We report on the above activity, looking at: partner views on progress; outcomes for campaign

creators; early impact of the campaigns.

Data is reported across the EYTO programme rather than by individual

countries to illustrate overarching progress towards achieving aims and objectives. However, the final evaluation report may explore country data and comparative differences if appropriate and relevant.

Appendix 1 of this report contains survey data tables for each country as they

may be of use to project leads in planning/developing the campaigns.


5

2. Findings

2.1 Partners - planning and management of

EYTO

This section explores the views of project leads on: key points in the EYTO journey; early outcomes for young people; learning about social marketing;

what has worked well so far. Data reported here was gathered at a focus group with partners held at the October 2014 exchange weekend.

2.1.1 The journey so far

Partners were able to identify three key stages of the EYTO journey to date:

1. The ‘kick off’ meeting in Luxemburg with project funders, which left partners feeling ‘that they were behind this, it was really important to

them’.

2. Review of existing social marketing interventions and team building in

each country (bringing together the necessary experts on health, communications, management, young people)

3. Determining the area of focus for each country:

a. Spain – to contribute to the evidence base for social marketing and

obesity reduction ‘we took a very scientific approach, with a

control group’. b. UK – to build understanding about how to change

behaviour/attitudes using social media. This is based on a perception that the UK is saturated in terms of marketing around health/food and the need to cut through this effectively.

c. Portugal – raising awareness of obesity as an issue rather than the normalised status it currently has – ‘We realised that the matter of

being overweight and obesity was not talked about between young people of that age. There is a lot of advertising for the young kids…but for the teenagers, we almost don’t have anything. Then it

starts again for the young adults’. d. Czech Republic – similar to Portugal, raising awareness of obesity

as an issue for young people.

In summary – there are three overarching ways in which the project has been conceived across the four countries – building evidence, raising awareness,

changing behaviours.

2.1.2 Early outcomes

At the time of the partner focus group, campaigns had just been launched, however, partners were able to identify a number of early changes that they

had noticed in campaign creators.


6

Campaign creators had begun to realise that social media is a route to achieving a more serious means. Originally keen and interested to learn

about social media, they were now beginning to focus on the ‘issue’ (obesity) as a more serious aspect of the project. ‘I have noticed a

change…our young people are so happy to use social media but after the presentations at the weekend, one young person said to me ‘you know what, it’s just a channel, it is not it.’ It was nice for me to hear and to see

that he has improved to [realise that to] use social media, which is so important to them, is not the work itself.’ (Czech Republic project lead)

The exchange weekend had helped increase confidence in young people and raise awareness of the context around the project. Many were nervous about presenting at the exchange weekend but managed to do it

successfully: ‘When we first met with our young people, one in particular said she felt very nervous about speaking in front of other people and

meeting new people, then yesterday she stood up and spoke in front of a room full of strangers from three other countries. So I think that’s been a big personal development.’ (UK project lead)

Young people were starting to learn about producing content via social media – rather than being passive participants.

2.1.3 Learning about social media/marketing

The experience of getting the projects off the ground provided insight and

learning into the use of social marketing as a tool for health development work:

There need to be tangible services underpinning campaign activities and events so that young people can ‘go somewhere’ and to support changing

behaviour rather than just raising awareness. ‘Early on, our young people realised that it’s all well and good making a very strong campaign with a look and feel and emotion around it, but if there’s not actually services

you can point people towards or things that can help people then it’s just a bit meaningless for your young people. So obviously they were aware

of the constraints of the projects, we can’t make all the kind of groups and services... so they’ve been very keen to link to this building here. This is a young centre that is focused on healthy living for young people’.

(UK project lead) Some approaches/uses of social marketing may be effective locally but

not necessarily scalable – for example, the UK model is built around a partnership with a local youth centre as a way to engage young people with services being delivered there

The assumption that young people engage with social media is not always correct – Spain have found it challenging to engage campaign

creators with social media for two reasons: firstly because they tend to engage with it passively rather than as content creators and, secondly, because of parental control in terms of access to social media. The

learning here has been the need to take into account young people’s exposure and access to social media – for example if they are limited to

closed-group applications such as Whatsapp. ‘The young people are really into their social media but they are users, they are not producers and it was difficult to get it working… We had to remind them over Whatsapp to

add something to the Facebook page’.


7

To produce an effective campaign you need to triangulate the interests of the key stakeholders (in this case policy, health experts and young

people) and design something that speaks to their concerns and needs

2.1.4 What works

Linked to learning about social marketing approaches and thinking about future development of the campaigns, partners identified a number of aspects that

support successful youth-led social marketing work.

1. Develop a bespoke approach to involving young people. The different circumstances of each country’s project led them to develop different ways of working with young people effectively. For example:

In Spain, working with teachers as gatekeepers to young people

was successful – ‘we told them who we needed to work with, so they didn’t ask for the ones with good scores but natural leaders’.

In the UK, the focus was on bringing together a group of young

people who were living challenging lives in deprived areas, this came with its own set of challenges (i.e. coordination and

engagement) which required a flexible approach. In the Czech Republic, the younger age of campaign creators – 14-

15 years old – meant they needed more support and pushing from

project leads than other countries.

2. Recruitment needs to take timing and context into account. This was a challenge for some of the countries – markedly the UK and Czech

Republic – and was identified as primarily a timing issue: ‘it was around exams, young people were under a lot of pressure and they weren’t coming to [youth centre] or other central gathering points’. In future it

would be good to give consideration to other pressures and activities young people are engaged in.

3. Actively manage content creation. In Spain, where engaging young

people to create social media content was tricky, it helped to allocate

responsibility for updating content on Facebook and twitter (as well as other platforms) to a different young person each day.

4. Bring people together. The exchange weekend was deemed to be a

marker of success ‘that we’ve managed to all be here with something to

show’. For Spain it was also an opportunity to draw parents into the project more.

5. Balancing youth-led approaches with the need to achieve project

outcomes. The partners agreed that balancing young people’s

motivation/engagement with the need to achieve project outcomes is challenging and they suspected there would be future challenges ahead

when the ‘fun creative’ side of the work gives way to more serious activity around obesity and health.


8

2.2 Campaign creators

This section presents interim evaluation findings based on two focus groups with the campaign creators at baseline and mid-point. It details their

experience of EYTO so far, as well as the extent to which they have increased skills and confidence in applying participatory social marketing techniques,

including: knowledge of the issue, communication and collaboration skills and the methods of social marketing.

2.2.1 Experience of EYTO

Across partner countries, young people were overwhelmingly positive about

their experience of EYTO. When asked whether they had achieved what they hoped from the project so far, one young person replied:

Definitely, I think it’s become even bigger than what I had imagined. Young person, UK

Other young people agreed that their involvement had met, and often exceeded, their initial expectations of the project. Below we outline the

outcomes young people hoped to achieve along with their views on the degree to which these have been met so far.

A desire to become healthier and motivate others to be so. Most

commonly, young people discussed joining the project to gain

information and the motivation to live a healthier lifestyle. One young

person in the UK noted ‘the timing was right’ to join the project as she

had recently began eating healthier and wanted to remain motivated to

do so. Young people in Portugal were keen to communicate that living a

healthy lifestyle does not have to be boring.

Create something interesting to share with friends/school peers.

Young people in Spain and the Czech Republic were especially interested

in creating a campaign to share with their school peers. Within the UK,

young people thought ‘it would be cool’ to create something ‘new’ while

one young person in the Czech Republic was interested in the prospect of

a young person-led campaign.

Meet new people and learn new skills. Others were excited by the

opportunity to work with young people from different countries. One

young person in the UK discussed being shy around new people and

hoped she would become more confident at public speaking through the

project.

For many, the most enjoyable aspect of the project so far was the exchange weekend in London, where young people met, made friends, shared

experiences and gained ideas for their campaigns. One young person in Portugal discussed how the weekend helped her understand the importance of


9

the project and place their campaign in a wider context. Another described feeling pride at having presented their project to the group.

2.2.2 Understanding of obesity and how to live a healthy lifestyle

A key step in development of young people’s campaigns to promote healthy lifestyles and awareness of obesity was gaining an understanding of these

issues and considering how to motivate young people to change their behaviours.

Campaign creators in the UK and Spain joined the project with a good

understanding of obesity. Young people in the UK discussed how stress, lack of discipline and readily available, cheap junk food contributed to young people’s

unhealthy lifestyles, while those from Spain linked obesity to wider public health issues, such as diabetes.

For these young people, involvement in EYTO has helped them to gain creative

ideas on how to live a healthy lifestyle. They described a range of ways in which the project had affected their lives. One young person in Spain stopped drinking

soft-drinks on discovering the levels of sugar; others shared information with their families. One young person in the UK spoke about encouraging her family to live a healthier lifestyle.

I’ve changed the whole diet in my house. I’ve created like this meal plan on the fridge… everyone in my house wants to lose weight!

Young person, UK However, campaign creators in Portugal and the Czech Republic started the

project with much less knowledge and awareness of obesity. They described being ‘shocked’ to learn that a high number of young people in their countries

were obese and the range of reasons that lead to this. One young person commented:

I have always thought about healthy lifestyles only in one way – how to lose weight. Now I see that it’s more complex. It’s also about motivation, about your emotions and your whole life.

Young person, Czech Republic

Another discussed how meeting other young people at the exchange weekend helped her to understand the scale of the issue.

It’s a problem in everyone’s country, not just Portugal, and I hadn’t

realised that before.

Young Person, Portugal


10

2.2.3 Knowledge, confidence and skills in developing

and implementing a social marketing campaign

One of the primary aims of EYTO is to increase young people’s knowledge, confidence and skills at using social marketing to tackle a health issue. This was assessed at the baseline and mid-point focus groups through participant

discussion and by asking the young people to map their confidence in a range of areas in order to measure change between the two time points (see Figures

1 and 2).

Social marketing

Campaign creators have developed their knowledge of social marketing through participating in EYTO, however, their understanding of it as a concept has

remained somewhat vague. At baseline, young people were able to identify the component parts of a social marketing campaign, believing it to include: Facebook, advertising, the internet and sharing information with other people.

At the midpoint group, young people still found it difficult to define social marketing but thought they had a better understanding of it and its composite

parts. With the benefit of hindsight, young people reflected that it would have been

helpful to have a practical example of a social marketing campaign (in addition to the one they developed) to bring the concept to life at the early development

sessions.

Communication and collaboration skills

Campaign creators were more likely to feel they had the confidence and skills to

engage with a range of communication activities following participation in EYTO. Figure 1 illustrates that at baseline 33 per cent of campaign creators felt they

had the confidence and skills to draft written material to get across key messages – at mid-point this had increased to 62 per cent. In addition, while at

baseline six of the creators did not think they had the skills to present to lots of people – by mid-point all campaign creators felt they had this skill ‘a bit’ or ‘a lot’.


11

In discussion with the participants it became clear that the exchange weekend had played a role in developing skills and confidence in communication.

When we first met, at the beginning of the project, we were like “I don’t want to speak in front of people” and then we just took charge!

All campaign creators agreed that they had made improvements in

collaborating with others:

At the beginning of the project, we were shy, and now we know how to

talk and communicate with others.

I feel more confident in my communication skills than at the beginning of

the project, because we had to talk with a lot of people that we didn’t

know and do presentations for a lot of people.

There was also some recognition that the next step in their work with EYTO

would be to transfer the newly gained confidence and communication skills to

campaign marketing: ‘I achieved part of my objectives…the important part is

done now [creating the campaign], but I realise that it is difficult to share the

information… now we need to transmit lifestyle information’.


12

Methods of social marketing

Finally, we looked at the degree to which young people felt confident and skilled

to produce or engage with various aspects of social marketing, for example: graphic design, creating branding, running events.

At baseline campaign creators were generally familiar with and confident about skills that were slightly more generic such as carrying out research, designing posters, organising events (see Figure 2); by midpoint there were small

increases in their confidence. However, findings indicate that involvement in EYTO has substantially increased skills and confidence the areas specific to

social marketing – communicating messages; graphic design; logo and website design (see Figure 2).

Young people described feeling proud of this work – for example, when the logo

they had designed came back from the designers – and that they had achieved something new.


13

There was also some acknowledgement from campaign creators that the skills gained through EYTO would be of benefit in other areas of their lives, for

example, college or future employment.

2.3 Wider impact – a snapshot survey

An online survey was designed to assess early impact of the EYTO campaigns as well as gather data on awareness and perceptions of campaign effectiveness and provide insight into the causes of obesity and barriers to leading a healthy

lifestyle.

2.3.1 Profile of respondents

A total of 139 respondents completed the survey between November 2014 and January 2015 (see Table 1). The majority of respondents were from Spain and

the Czech Republic. This is perhaps not surprising as these campaigns were the furthest developed. Nearly two-thirds of respondents (65 per cent) were female

and just over half (52 per cent) were aged between 14 and 16 years old. Four out five respondents (78 per cent) attended school or college and a similar

number stated they did not work (77 per cent).

Table 1: Profile of respondents

% N

Country

United Kingdom 14 20

Spain 35 49

Portugal 10 14

Czech Republic 40 56

Gender

Male 35 48

Female 65 91

Age

Under 10 3 4

11-13 12 17

14-16 52 72

17-19 13 18

20-22 1 2

23-25 1 2

Over 25 17 24

Education status

Attends school/college 78 109

Attends university 4 5

Does not attend either 18 25

Employment

status

Works full-time 13 18

Works part-time 10 14

Does not work 77 107

Source: All respondents (N = 139)


14

Respondents were asked to categorise how they viewed their current lifestyle. Table 2 indicates that 42 per cent believed that they had a healthy lifestyle but

still wanted to make some changes to their diet and exercise routine. However, nearly a third of respondents (30 per cent) said that they did not want to make

any changes to their diet or exercise routine

Table 2: Which statement best describes you at this moment in time?

% N

I live a healthy lifestyle and I don’t need to make any

changes to my diet and exercise routine. 24 33

I live a healthy lifestyle but I still want to make some


I don’t live a very healthy lifestyle at all and I want to

make any changes to my diet and exercise routine. 21 29

I don’t live a very healthy lifestyle at all and I don’t want

to make any changes to my diet and exercise routine. 6 8

I don’t know 8 11

Source: All respondents (N = 139)

2.3.2 Access and effectiveness of the EYTO campaigns

Respondents were asked to indicate their involvement or participation with the

campaign (see Figure 3). Three out of five respondents (63 per cent) had accessed the Facebook page for the campaign and one in five (22 per cent) had

attended a pop up event. Just two per cent had engaged with a twitter feed or postcards produced.

Figure 3. Ways in which survey respondents engaged campaign activities


15

Source: All respondents (N = 139). Note, respondents could choose more than one

response.

Overall, the majority of respondents felt that the campaign was effective to some degree in terms of engaging with young people and motivating and

showing them how to make healthy lifestyle choices (Table 3):

Nearly 90 per cent of respondents believed that the campaign was either

somewhat (58 per cent) or very (30 per cent) effective in encouraging young people to eat a more healthy diet and be more physically active.

83 per cent of respondents felt that the campaign had been somewhat

(42 per cent) or very (41 per cent) effective in both motivating and showing young people how to eat a healthy diet and be physically

active.

Table 3: Respondent rating of campaign effectiveness

Not at all

effective

Not very

effective

Somewhat

effective

Very

effective

% % % %

Overall effectiveness of the

campaigns at encouraging young

people to eat a more healthy diet and be more physically active.

4 9 58 30

Engaging young people in eating a

healthy diet and becoming physically active.

5 12 54 29

Communicating why it is

important to eat a healthy diet and be physically active.

2 9 40 50


16

Motivating young people to eat a

healthy diet and be physically active.

4 13 42 41

Showing young people how to eat

a healthy diet and be physically

active through practical suggestions for their day-to-day life.

3 14 42 41

Source: All respondents (N = 139).

2.3.3 Impact of campaigns

To begin to understand the impact of campaigns, respondents were asked what

they had done as a result of viewing or engaging with the campaign. Figure 4 highlights that 37 per cent of respondents had spoken about the campaign to a parent or friend. Just over a third of respondents (35 per cent) had also

thought about eating a healthy diet and being physically active but only 17 per cent had actually made a change to their diet and been more physically

active.

Figure 4: As a result of the campaign, have you done any of the following or do

you plan to in the future?

5

6

17

17

24

25

35

37

0 5 10 15 20 25 30 35 40

I don’t know

None of the above

Nothing yet – maybe later

Made a change to eat a more healthy diet and bemore physically active

Tried to find out more about healthy eating orbeing physically active

Shared a link about the campaign or informationwith a parent/friend

Thought about eating a healthy diet and beingphysically active

Spoken about the campaign with a parent/friend


response.

It appears that respondents were more likely to speak with peers and family than interact with the campaign via social media (i.e. sharing the link).


17

Of respondents who stated that they did not need to make any changes to their lifestyle, 5% had made a change following engagement with the campaign and

12% had spoken to a friend or family member about it. The largest number of those who had taken action as a result of the campaign were respondents who

said they already lived a healthy lifestyle but wanted to make some changes – 25% spoke about the campaign with a friend/family member and 15% made a change to their lifestyle.

2.3.4 Views on obesity – causes, enablers and barriers to making healthy choices

Causes of obesity

Respondents to the survey were asked what they felt were the main causes of obesity in young people. Table 4 indicates that three-quarters of respondents

(75 per cent) thought obesity was caused by eating too much, followed closely by two-thirds (67 per cent) believing that not doing enough physical activity was an issue. The majority of respondents selected multiple options – 46 per

cent chose 4-6 options – suggesting that obesity is seen as a multifaceted issue with multiple causes.

Table 4: What do you think causes some young people to be obese?

% N

Eating too much unhealthy food 75 35

Not doing enough physical activity 67 93

Being lazy 55 76

Not eating enough fruits and vegetables 47 65

Sitting down a lot 41 57

Boredom 38 53

Other people eating unhealthily around them 35 48

Feeling down 34 47

Eating too much generally 32 45

Parents/carers only providing unhealthy food 27 38

Genetics 21 29

Being lonely 18 25

Healthy food is expensive 15 21

Lack of information about how to lose weight 12 16

Result of a medical condition 11 16

Being unlucky 6 8

Having a disability 6 8


response.


18

When asked to select the three most important causes of obesity, over half of respondents identified eating too much unhealthy food (53 per cent) and just

under half selected not doing enough physical activity (48 per cent) as the most important causes (see Figure 5).

Figure 5. Of your answers, what do you think are the three most important

factors that cause obesity?


19


response.

To explore the perceived causes of obesity further, the most commonly selected options were coded as ‘internal’ or ‘external’ according to whether they were

the result of internal or external factors (see Appendix 1 for coding). This analysis showed that respondents viewed obesity as the result of primarily

internal factors (see Table 5).

Table 5. CODED: Of your answers, what do you think is the most important?

% N


20

Internal – unhealthy eating 56 79

Internal – inactive lifestyle 53 73

Internal – emotional 34 47

External – lack of access 23 32

External – medical/genetics 9 13


response

What helps young people to lead a healthy lifestyle

Two-thirds (65 per cent) of respondents said that having support from their parents/carers would help young people to make healthy choices (Table 6) and 60 per cent believed having access to sports and other physical activities would

help young people to make healthy choices.

Table 6. What helps young people to make healthy choices?

% N

Support from their parents/carers to get healthy 65 90

Access to opportunities for sports and other

physical activities 60 83

Having someone to exercise with 53 73

Enjoying physical activity 53 73

Enjoying healthy eating 47 65

Access to healthy food 46 64

Seeing the benefits from making healthy choices 42 59

Support from school to get healthy 38 53

Caring about the way they look 38 53

Knowledge and understanding of how to be

healthy 32 44

Support from their friends to get healthy 31 43

Having time to think about being healthy 18 25


response.

When asked to say what was the most important aspect of helping young people to make healthy choices, respondents identified: support from their

parents/carers (40 per cent) and accessing sporting and physical activities (27 per cent). Interestingly, caring about the way you look (22 per cent) was seen

as the third most important factor in helping young people to make healthy choices.


21

In contrast with the causes of obesity, being able to live a healthy lifestyle was viewed by respondents as dependent on a combination of external and internal

factors for example – support from parents/access to activities (external) and enjoying healthy eating/caring about the way you look (internal) (see Figure 6).

Figure 6. What are the three most important factors that help young people to

make healthy lifestyle choices?


response.

Barriers to leading a healthy lifestyle

Not getting enough exercise (55 per cent), lacking motivation to change (52 per cent) and a lack of will power (52 per cent) were seen as the main factors that

stop young people from developing healthy lifestyles (Table 7).


22

Table 7. What stops young people from making healthy choices and living a

healthy lifestyle.

% N

Not getting enough exercise 55 76

Lacking motivation to change 52 72

Lack of will power 52 72

More unhealthy than healthy foods in the house 49 68

Not liking working out 45 63

Temptation 43 60

Not being able to break bad eating habits 41 57

Enjoying unhealthy foods more than healthy foods 40 56

Lack of support from friends/family to make changes 32 44

Unhealthy foods are cheaper than healthy foods 31 43

Being with friends who eat unhealthily 24 33

Lack of discipline 23 32

Not having access to a place to work out 20 28

Not enough healthy meals available in schools 20 28

Not having the time to make a change 18 25

Not knowing enough about calories 17 24

Hidden salt and sugar in foods 14 20

Not knowing how to cook 14 19

Being too busy 13 18

Medical condition 9 12


response.

Again, respondents were asked to decide what they felt were the most important factors stopping young people from making healthy lifestyle choices

(Figure 7). Internal factors were cited as the main barrier: a quarter of respondents (25 per cent) felt that lacking the motivation to change was one of

the most important factors, followed by a lack of will power (19 per cent) and not liking working out (19 per cent) (see Table 8).


23

Figure 7. What are the three most important factors that stop young people

from making healthy lifestyle choice?


response.

Table 8: CODED: Of your answers, what do you think are the three most

important factors that stop young people from making healthy lifestyle choice.

% N

Internal – emotional/will power 72 100

External – access 35 49

Lifestyle – time, inactive 25 34

External – support 8 11

Internal – awareness/

knowledge 7 9

Medical / genetic 4 6


response


24

3. Conclusion

In this concluding section, we highlight key points from the interim evaluation

findings and reflect on what they may mean for the development of EYTO.

Key findings

Early findings indicate that EYTO is achieving its aim of increasing the skills and confidence of campaign creators in applying social marketing techniques. The

majority of participants have made clear progress in this area and are motivated to remain engaged with the programme as it moves to the next

phase.

The initial targets outlined in the programme objectives are that the campaigns will increase the motivation to live healthily in 80 per cent of the young people

who engage with them and result in 60 per cent reporting that they have increased their physical activity or healthy eating as a result. At this stage, we

are able to say that EYTO is effective in improving motivation: 96 per cent overall have discussed the campaign; thought about making a change to their lifestyle; or tried to find out more about living healthily. However, just 17 per

cent have made a change to their behaviour in terms of eating or exercise habits. This finding is not unexpected and may be accounted for by the fact that

the survey data was gathered during early stages of the campaigns.

Finally, the survey data highlights that young people perceive obesity to be a complex issue – determined by a range of internal and external factors. The

main barriers to making healthy lifestyle choices were identified as lack of exercise, motivation and will power. Young people thought that more support

from parents and greater access to activities would help them to live healthier lives.

Learning and recommendations

1. Campaign creators may need further support to understand what social

marketing is, how it can be used as a tool to achieve a clear purpose, and

how their campaign fits within the wider context of health campaign

activity.

2. Campaign creators identified the exchange weekend as one of the most

important parts of EYTO. Given the appetite for working across countries,

it might be useful to facilitate other ways that young people could

collaborate to share campaign progress and ideas, for example via Skype

sessions or by making videos for other countries to share learning.

3. As the campaigns move into the next phase – influencing behaviour

change through social marketing – there is recognition among partners

and creators that the more serious work is beginning and young people

may require further support in this phase.


25

Appendix 1: Internal/external survey codes

Q6 What do you think causes some young people to be obese?

Code

Boredom Internal - emotional

Feeling down Internal - emotional

Being lazy Internal - emotional

Being unlucky Internal - emotional

Being lonely Internal - emotional

Lack of information about how to lose weight External - lack of access

Parents/carers only providing unhealthy food External - lack of access

Healthy food is expensive External - lack of access

Other people eating unhealthily around them External - lack of access

Not doing enough physical activity Inactive lifestyle

Sitting down a lot Inactive lifestyle

Eating too much unhealthy food Unhealthy eating

Eating too much generally Unhealthy eating

Not eating enough fruits and vegetables Unhealthy eating

Genetics Medical/Genetic

Result of a medical condition Medical/Genetic

Having a disability Medical/Genetic

Q7 What helps young people to make healthy choices

Code

Knowledge and understanding of how to be healthy

Awareness/knowledge

Having time to think about being healthy Awareness/knowledge

Enjoying healthy eating Internal - caring/enjoying

Seeing the benefits from making healthy choices

Internal - caring/enjoying/seeing

benefits

Enjoying physical activity Internal - caring/enjoying

Caring about the way they look Internal - caring/enjoying

Support from their parents/carers to get healthy

External - support/motivation

Access to opportunities for sports and other physical activities

External - support/motivation

Support from school to get healthy External - support/motivation

Having someone to exercise with External - support/motivation

Support from their friends to get healthy External - support/motivation

Access to healthy food External - access


26

Choice Q8 what stops young people Code

Temptation Internal - emotion/will power

Not liking working out Internal - emotion/will power

Lacking motivation to change Internal - emotion/will power

Enjoying unhealthy foods more than healthy foods

Internal - emotion/will power

Lack of discipline Internal - emotion/will power

Not being able to break bad eating habits Internal - emotion/will power

Lack of will power Internal - emotion/will power

Not knowing enough about calories Awareness/knowledge

Not knowing how to cook Awareness/knowledge

Medical condition Medical/Genetic

Unhealthy foods are cheaper than healthy foods

External - access

More unhealthy than healthy foods in the house

External - access

Not having access to a place to work out External - access

Hidden salt and sugar in foods External - access

Not enough healthy meals available in schools External - access

Being with friends who eat unhealthily External - support

Lack of support from friends/family to make

changes

External - support

Not getting enough exercise Lifestyle - time

Not having the time to make changes Lifestyle - time

Being too busy Lifestyle - time


27

Appendix 2: Country tables

1. UK

Table 1.1: Profile of respondents

% N

Gender

Male 5 1

Female 95 19

Age

Under 10 10 2

11-13 10 2

14-16 35 7

17-19 20 4

20-22 10 2

23-25 0 0

Over 25 15 3

Education status




Employment status



Does not work 65 13

Source: All respondents (N=20)

Table 1.2: You just viewed the campaign’s Facebook page, have you received

or engaged with any of these other activities hosted by the campaign?

% N

Facebook page 20 4

Pop up event 20 4

Online video/YouTube 10 2

Leaflet 15 3

Instagram 15 3

Posters 20 4

Newspaper advert 5 1

Twitter feed 0 0

Postcard 5 1

None of these 10 2

I don’t know 15 3

I can’t remember 5 1

Source: All respondents (N=20). Note, respondents could choose more than one

response.


28

Table 1.3: How effective do you think the campaign is overall at encouraging

young people to eat a more healthy diet and be more physically active?

Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %

Overall effectiveness of the campaigns at

encouraging young people to eat a more

healthy diet and be more physically active. 5 0 55 40

Source: All respondents (N=20).

Table 1.4: How would you rate the campaign at the following?

Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %

Engaging young people in eating a healthy

diet and becoming physically active. 5 0 40 55


a healthy diet and be physically active. 5 5 25 65

Motivating young people to eat a healthy

diet and be physically active. 5 5 40 50


healthy diet and be physically active

through practical suggestions for their day-

to-day life. 5 5 35 55

Source: All respondents (N=20 ).

Table 1.5: Which of the following statements best describes you at this

moment in time?

% N









I don’t know 5 1



29

Table 1.6: As a result of the campaign, have you done any of the following or

do you plan to in the future?

% N

Shared a link about the campaign or information with a

parent/friend 5 1

Spoken about the campaign with a parent/friend 20 4

Thought about eating a healthy diet and being physically active 30 6

Made a change to eat a more healthy diet and be more physically

active 20 4

Tried to find out more about healthy eating or being physically

active 20 4

Nothing yet – maybe later 10 2

None of the above 5 1

I don’t know 10 2


response.

Table 1.7: In your opinion, what do you think causes some young people to be

obese?

% N

Eating too much unhealthy

food 80 16

Not doing enough physical

activity 50 10

Being lazy 50 10


vegetables 35 7


Boredom 55 11


around them 5 1

Feeling down 55 11



unhealthy food 20 4

Genetics 15 3

Being lonely 25 5


Lack of information about how

to lose weight 15 3


Being unlucky 0 0



response.


30

Table 1.8: Of your answers, what do you think is the most important?

% N


food 50 10


activity 20 4

Being lazy 20 4


vegetables 5 1

Boredom 30 6



around them 0 0

Genetics 0 0

Feeling down 10 2


unhealthy food 5 1



Being lonely 0 0

Being unlucky 0 0


to lose weight 0 0



Source: All respondents (N=20). Note, respondents could choose between one and

three responses only.

Table 1.9: In your opinion, what helps young people to make healthy choices

and live a healthy lifestyle?

% N


Access to opportunities for sports and other physical activities 40 8








Knowledge and understanding of how to be healthy 25 5




response.


31


% N















Table 1.11: In your opinion, what stops young people from making healthy

choices and living a healthy lifestyle? % N

Temptation 55 11



















Being too busy 30 6


response.


32


% N

Temptation 25 5



















Being too busy 10 2




33

2. Spain

Table 2.1. Profile of respondents

% N

Gender

Male 41 20

Female 59 29

Age

Under 10 0 0

11-13 14 7

14-16 65 32

17-19 2 1

20-22 0 0

23-25 2 1

Over 25 16 8

Education status




Employment status

Works full-time 8 4


Does not work 82 40


Table 2.2. You just viewed the campaign’s Facebook page, have you received


% N

Facebook page 69 34

Pop up event 31 15


Leaflet 10 5

Instagram 0 0

Posters 6 3


Twitter feed 2 1

Postcard 4 2

None of these 14 7

I don’t know 2 1



response.


34

Table 2.3. How effective do you think the campaign is overall at encouraging


Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %





Table 2.4. How would you rate the campaign at the following?

Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %










to-day life. 0 10 43 47


Table 2.5. Which of the following statements best describes you at this

moment in time?

% N









I don’t know 4 2



35

Table 2.6. As a result of the campaign, have you done any of the following or


% N


parent/friend 29 14




active 22 11


active 31 15



I don’t know 6 3


response.

Table 2.7. In your opinion, what do you think causes some young people to be

obese?

% N


food 86 42


activity 78 38

Being lazy 47 23


vegetables 57 28


Boredom 37 18


around them 35 17

Feeling down 45 22



unhealthy food 29 14

Genetics 18 9

Being lonely 14 7



to lose weight 8 4


Being unlucky 0 0



response.


36

Table 2.8. Of your answers, what do you think is the most important?

% N


food 59 29


activity 61 30

Being lazy 6 3


vegetables 20 10

Boredom 10 5



around them 6 3

Genetics 8 4

Feeling down 8 4


unhealthy food 12 6



Being lonely 4 2

Being unlucky 0 0


to lose weight 2 1





Table 2.9. In your opinion, what helps young people to make healthy choices


% N














response.


37


% N















Table 2.11. In your opinion, what stops young people from making healthy

choices and living a healthy lifestyle?

% N

Temptation 53 26



















Being too busy 12 6


response.


38


% N

Temptation 27 13



















Being too busy 2 1




39

3. Portugal

3.1. Profile of respondents

% N

Gender

Male 29 4

Female 41 10

Age

Under 10 0 0

11-13 0 0

14-16 36 5

17-19 36 5

20-22 0 0

23-25 0 0

Over 25 29 4

Education status




Employment status


Works part-time 0 0

Does not work 71 10




% N

Facebook page 50 7

Pop up event 0 0


Leaflet 14 2

Instagram 0 0

Posters 0 0


Twitter feed 0 0

Postcard 0 0

None of these 43 6

I don’t know 7 1



response.


40



Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %






Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %










to-day life. 0 7 57 36



moment in time?

% N









I don’t know 7 1



41



% N


parent/friend 21 3




active 7 1


active 29 4



I don’t know 0 0


response.


obese?

% N


food 64 9


activity 93 13

Being lazy 86 12


vegetables 64 9


Boredom 36 5


around them 79 11

Feeling down 50 7



unhealthy food 43 6

Genetics 29 4

Being lonely 50 7



to lose weight 7 1


Being unlucky 0 0



response.


42


% N


food 43 6


activity 64 9

Being lazy 36 5


vegetables 21 3

Boredom 7 1



around them 57 8

Genetics 7 1

Feeling down 14 2


unhealthy food 7 1



Being lonely 14 2

Being unlucky 0 0


to lose weight 0 0







% N














response.


43


% N

















% N

Temptation 50 7



















Being too busy 0 0


response.


44


% N

Temptation 36 5



















Being too busy 0 0




45

4. Czech Republic

Table 4.1. Profile of respondents

% N

Gender

Male 41 23

Female 59 33

Age

Under 10 4 2

11-13 14 8

14-16 50 28

17-19 14 8

20-22 0 0

23-25 2 1

Over 25 16 9

Education status




Employment status


Works part-time 9 5

Does not work 79 44




% N

Facebook page 77 43

Pop up event 20 11


Leaflet 13 7

Instagram 18 10

Posters 5 3


Twitter feed 4 2

Postcard 0 0

None of these 5 3

I don’t know 2 1



response.


46



Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %






Not at

all

effective

Not very

effective

Somewh

at

effective

Very

effective

% % % %










to-day life. 5 21 41 32



moment in time?

% N









I don’t know 13 7



47



% N


parent/friend 30 17




active 13 7


active 18 10



I don’t know 4 2


response.


obese?

% N


food 66 37


activity 57 32

Being lazy 55 31


vegetables 38 21


Boredom 34 19


around them 34 19

Feeling down 13 7



unhealthy food 25 14

Genetics 23 13

Being lonely 11 6



to lose weight 14 8


Being unlucky 14 8



response.


48


% N


food 50 28


activity 43 24

Being lazy 27 15


vegetables 18 10

Boredom 7 4



around them 7 4

Genetics 13 7

Feeling down 4 2


unhealthy food 4 2



Being lonely 6 3

Being unlucky 7 4


to lose weight 2 1







% N














response.


49


% N

















% N

Temptation 29 16



















Being too busy 11 6


response.


50


% N

Temptation 2 1



















Being too busy 4 2



an evaluation of european youth tackling obesity (eyto); a ... · • there is evidence of...

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