Food4Health: Final Project Report by Cense

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Food4Health A Youth Leadership Project for Health Promotion

Youth Voices Research Group Dalla Lana School of Public Health University of Toronto

Final Report June 14th, 2009

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Youth Leaders: Food4Health Final Report

Table of Contents Project Overview

Activities, Achievements and Outcomes

1. Community Action Projects

1.1 Stomach This!

1.2 Food4You!

1.3 4H Ontario Leadership Training and Evaluation

1.4 Growing Reflections, Understanding Bites

1.5 Ontario Agri-Food Education in the Classroom

2. Research and Evaluation

2.1 Review of Youth Engagement & Evaluation Practices

2.2 Systematic Literature Review: Youth Engagement & Health

2.3 Systematic Review on Private Public Partnerships 4 Health

2.4 Food4Health Evaluation Model

3. Knowledge Translation

3.1 Social Media

3.2 Partnership Development

3.3 Public Events

3.4 Promotional Materials

4. Concluding Remarks

5. Appendices:

5.1 Executive Summary

5.2 Summary Table of Results

5.3 Multiculturalism Report

5.4 Internal Evaluation Report

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Youth Leaders: Food4Health Food â&#x20AC;&#x201C; from what we eat to how we eat to the way its produced, marketed and disposed of â&#x20AC;&#x201C; plays a vital role in sustaining life and promoting health and well-being. At the same time, what we eat contributes to many of the leading causes of chronic disease and illness. Food4Health aims to provide a bridge between the agrifood and health with a focus on the future leaders in our community: youth and young adults. For youth to be able to take leadership in shaping our food system, it is critical that they have the knowledge to make healthy decisions and both the skills and tools necessary to bring about positive change in their community. This project was designed to provide a foundation for a chronic disease platform that would create a network of youth engagement projects that would link innovators from different sectors together with youth and young adults to provide leadership opportunities for them to direct health promotion activities in their communities. Rather than develop programs, the Food4Health initiative was designed to optimize groups already doing work in the community by providing them with evaluation tools, networking opportunities, and collaboration options to enable them to disseminate their activities to new audiences. It also provided a forum for youth interested in taking action on shaping our food system â&#x20AC;&#x201C; from food security, safety and sovereignty issues to tackling diet and nutrition problems â&#x20AC;&#x201C; to come together, learn and share their knowledge with each other. Through the TakingITGlobal online community of youth with its 230,000 members, tools like Facebook and Twitter, and through face-to-face interactions between adults and young people this initiative aimed to put food and health into a glocal (global + local) context relevant to youth. Mission:

To foster an activated, knowledgeable and enthusiastic youth and young adult population committed to promoting health and well-being through food systems transformation involving engaged partnerships from across the agrifood, health, education, and technology spectrum.

Vision:

A healthy, equitable, and creative Ontario

Objective:

To connect youth and youth-serving organizations together to provide evaluation, networking and coordination support for a systems-oriented strategy to transform our food system and stimulate world-leading health promotion and chronic disease prevention innovation

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Food4Health Activities, Achievements and Outcomes The first phase of Youth Leaders: Food4Health (Food4Health) was a proof-of-concept initiative designed to provide innovative organizations working at the crossroads of agrifood, public health and education with evaluation, knowledge translation and partnership development support aimed at establishing a food systems approach to health promotion. Health promotion, as conceived of here, is a multi-strategy, crosssectoral and collaborative effort aimed at pro It also provided an opportunity to advance our understanding of the needs and wants of youth as it pertains to food systems issues and synthesize the latest evidence on youth engagement and developing effective multi-sectoral â&#x20AC;&#x153;

partnerships. The initiative consisted of a series of demonstration projects aimed at developing a sustainable strategy for youth engagement on food systems issues, including chronic disease prevention, using a threepronged, linked and coordinated framework of: 1) Community Action Projects, 2) Research & Evaluation, and 3) Knowledge Translation. These three activities were often embedded within each other reflecting the complex needs of health promotion.

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Underlying this framework was a desire to optimize the work of existing programs by providing them with critical support in these three areas. This included providing resources to extend existing programming into areas that were previously inaccessible, yet consistent with the organizationâ&#x20AC;&#x2122;s mandate and interest in building links between the three areas of agrifood, public health and education. The Youth Voices Research team committed to providing programmatic, tactical, evaluation and networking support for these projects, while communicating about them to the wider community through social networking tools like Twitter (@food4health), Facebook, and the TakingITGlobal online engagement platform (http:// www.tigweb.org). This resulted in more than 300 project updates such as blogs and Twitter posts throughout the life of the life of the project. This social media engagement also attracted more than 100 committed followers via Twitter, nearly 50 Facebook â&#x20AC;&#x2DC;friendsâ&#x20AC;&#x2122; from around Ontario, and thousands of visits to the TiG Food4Health project page -- even though the overall promotion of the sites were limited due to the timing of the project.

1. Community Action Projects Food4Health provided an opportunity to mobilize a partnership that had been developed to support cross-sectoral health promotion and food systems transformation through a coherent and connected set of community-based program activities. These included several highly focused community-based demonstration projects aimed at

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exploring models of youth engagement within the Participant: â&#x20AC;&#x153; ! & ' framework of food, nutrition and healthy eating. The .& & . ! ! ! + & goal of this work was to describe youth interests and ' & & % '! & ideas regarding food issues, and explore with young people how social change in relation to nutrition, food ( ! $ ! # " ! $! ! ! & and healthy eating could advance healthy choices and outcomes, particularly for at-risk groups. ! !+, Engagement projects were grounded in the Youth Voices Action Process, which has been used in more than 20 projects with young people around the world to encourage critical thinking and social action for health promotion. Six action projects were undertaken, in collaboration with various partners from education to community-based organizations.

1.1 Stomach This! Stomach This! was initiated by MealExchange, an established charitable group focused on addressing issues of local hunger using a student-focused, youth-driven approach, in response to the growing desire among their student volunteer base for more options in addressing issues of food sovereignty in their communities. Stomach This! used a popular education model to train youth as leaders with the goal of teaching youth leaders how to deliver peer-driven training programs to engage young people on issues of food security. This â&#x20AC;&#x2DC;train-the-trainerâ&#x20AC;&#x2122; model is designed to provide a sustainable model for health promotion on food issues in high schools, colleges and university campuses throughout Ontario and eventually Canada-wide. The Food4Health team provided resources to deliver the workshop, tactical support and designed and implemented the evaluation of the one-day event as a pilot for youth engagement strategies. The goal of the project was to increase participantsâ&#x20AC;&#x2122; knowledge, skills and overall competence in training would then return to their respective communities as facilitators with the goal of delivering similar workshops to their peers. The Stomach This! workshop was piloted tested on March 21 2009 with 20 youth aged 15-24 from a diverse range of cultural, socio-economic and educational backgrounds. Their goal was to broaden their knowledge of hunger and food security, and to learn how to take action on these issues. The learning objectives for the workshop were two-fold:

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Enable participants to learn about food security issues largely through discussion

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Enable participants to learn how to deliver a workshop on food security by gaining facilitation skills based on popular education principles.

Content for the workshop was developed by Meal Exchange, along with a facilitator from Check Your Head (specialists in popular education strategies) who adapted the content and prepared the following workshop activities: â&#x20AC;˘ Thermometer of Hopes and Fears â&#x20AC;&#x201C; Participants outlined their hopes and fears as peer facilitators â&#x20AC;˘ Approaches to Education â&#x20AC;&#x201C; Brainstorming different ways that people learn and how to adapt as a facilitator

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â&#x20AC;˘ World CafĂŠ â&#x20AC;&#x201C; This session saw youth discuss hunger and poverty in Canada and the role they play in addressing these issues â&#x20AC;˘ Personal Commitment â&#x20AC;&#x201C; Participants made personal commitments on the changes they will make in their own lives to address food security and how they will get involved with their community â&#x20AC;˘ Workshop Delivery Time â&#x20AC;&#x201C; A grand run through of the workshop with â&#x20AC;&#x153;participantsâ&#x20AC;? now leading the charge as â&#x20AC;&#x153;facilitatorsâ&#x20AC;? Outcomes An evaluation of the Stomach This! training initiative was conducted using surveys administered before and after the workshop. 18 participants out of a possible 20 responded to the pre-test and 9 participants responded to the post-test survey, which was delivered after the workshop via the Internet. Overall, the evaluation demonstrated that the training met the expectations of participants. When asked about any outstanding or â&#x20AC;&#x153;wowâ&#x20AC;? moments during the training, participants spoke to the value in meeting other energized young people, learning more about food security and experimenting with the facilitation techniques. Evaluation questionnaires identified changes in participantsâ&#x20AC;&#x2122; knowledge of food security issues and confidence in conveying information about food security issues (i.e.; knowledge and attitude outcomes) and assessed participants' readiness to take action on food security issues following the training. Data from the 8 participants who responded to both the pre-test and post-test survey reported that the Stomach This! training facilitated knowledge and attitude changes. Key areas of change revolved around knowledge of the concept of food security, including strategies that affect food security. Specifically, prior to the training, only 25% of respondents ranked themselves as a â&#x20AC;&#x153;9â&#x20AC;? on a scale of 1 -10 to demonstrate a strong understanding â&#x20AC;&#x153;of the concept of food securityâ&#x20AC;?. Following the training, 63% of respondents ranked themselves as â&#x20AC;&#x153;9â&#x20AC;? to describe their understanding â&#x20AC;&#x153;of the concept of food securityâ&#x20AC;?. In addition, there was demonstrable change revealing increased levels of understanding around the relationship between poverty and food security, its impact on personal well-being, and the positive link with community action.

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In addition to revealing changes in knowledge and attitudes around food security, participants also demonstrated that they had begun to take action around food security issues based on activities related to the training. For instance, following the training 67% of respondents agreed, or strongly agreed, that they had begun to take action to achieve the food security commitment that they had made at the Stomach This! training. Over half of participants (56%) intended to run the Stomach This! workshop in their communities within the two months following the training, and all participants agreed, or strongly agreed, that they would connect with other participants at the training within the following month. Next Steps

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Stomach This! provided Meal Exchange with an opportunity to grow and the evaluation data (and strategy) to help reflect on their programming and inform the further development of their outreach initiatives. The organizationâ&#x20AC;&#x2122;s staff now feel better equipped to share information on food security with the young people they work with using popular education strategies. Meal Exchange plans to continue to support existing Stomach This! trainers and to continue this training as part of the professional development of their youth coordinators, as well as external training for other community organizations.

1.2 Food4You! Food4You! was a one-day â&#x20AC;&#x2DC;unconferenceâ&#x20AC;&#x2122; designed to provide an opportunity for learning and dialogue around food systems issues with diverse communities. In partnership with Drs Alex Jadad and Andrea Cortinois at the Centre for Global eHealth Innovation, the Food4Health team identified opportunities to engage diverse youth populations in discussion and action on food choices and food security. The â&#x20AC;&#x2DC;unconferenceâ&#x20AC;&#x2122; format is designed to put the agenda in the hands of the participants and has been used by the Youth Voices Research Group in alternate formats as a means to engage youth and adults in dialogue. Youth and young adults from a variety of backgrounds, industry leaders, academics and representatives from various community organizations participated in the â&#x20AC;&#x2DC;unconferenceâ&#x20AC;&#x2122; hosted at Hart House at the University of Toronto on April 21st 2009. The event brought together 34 youth and 25 adults who were organized into small groups based on themes developed by all participants in the first part of the event. Format of the day: â&#x20AC;˘Warm-up exercises were conducted through which participants introduced themselves to each other and began to address concepts of food security â&#x20AC;˘All attendees were then given the opportunity to jointly define the agenda for the day â&#x20AC;˘A united group discussion led to the creation of five major topic areas

1. 2. 3. 4. 5.

â&#x20AC;&#x153;Schools and Foodâ&#x20AC;? â&#x20AC;&#x153;Understanding Food Securityâ&#x20AC;? â&#x20AC;&#x153;What Brought Us Hereâ&#x20AC;?

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â&#x20AC;&#x153;Global to Localâ&#x20AC;? â&#x20AC;&#x153;The Food Industryâ&#x20AC;?

â&#x20AC;˘Participants all enjoyed a locally sourced lunch â&#x20AC;˘Breakout sessions were then organized, based on the five major topic areas identified â&#x20AC;˘Participants were invited to join a session of their choice, in the knowledge that they were able to move freely between any of the five discussions as they saw fit â&#x20AC;˘Each breakout session was supported by an experienced facilitator whose primary capacity was to record all ideas and concepts coming from the group, and keep discussion flowing. â&#x20AC;˘Finally, participants were brought back together to share their thoughts, issues and solutions concerning the issues under investigation.

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Outcomes The Food4You! un-conference model provided a highly participatory means of engaging a wide range of youth and facilitate their connection to community agencies and each other. Youth and community partners were affiliated with such diverse organizations as FoodShare, Growing Thumbs Growing Kids, Regent Park Focus, Canadian Farmerâ&#x20AC;&#x2122;s Alliance, Lawrence Heights Middle School, Sketch Community Arts for Street Youth, Supporting Our Youth, Meal Exchange and STOP Community Food Program. Participants learned from one another to develop and share an understanding of what food security meant to them, while collectively addressing concerns and envisioning community # based solutions.

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Although the five participant-designed breakout sessions addressed varying topics, several thematic issues and solutions were found across the board:

1.The idea that food is too expensive and choice is limited in schools;

2.Food education is not comprehensive enough (both in terms of physical health, such as nutrition, and mental health, such as eating disorders); 3. â&#x20AC;&#x153;We are the food industryâ&#x20AC;? and thus, through action, have control over what foods we eat, how they are produced, and where they come from.

Feasible solutions that focus on community involvement and personal actions were encouraged and envisioned. Simple activities such as starting an after school club whereby students competitively cook reasonably priced, nutritious meals, of which the winning recipe is sold in the cafeteria, were conceived. This illustrates an example of fostering a youth-led connection between students and their foods while championing healthier alternatives in schools. There was also a large emphasis on developing novel educational programs, such as introducing a food component to various academic subjects ranging ' from geography to physical education to biology " # and if possible, even field trips to food production sites (i.e. farms, greenhouses, community gardens, etc.). Many of these ideas were ones that could translate into novel approaches to after-school # ! ! &( * + programming and service learning opportunities.

Next Steps The long-term effects of the project and the â&#x20AC;&#x153;un-conferenceâ&#x20AC;? are already becoming visible. Youth attendees from the Institute at Havergal shared their Food4you! experiences with 100 of their fellow students by implementing a food security themed day at their school with breakout sessions based on those at the Food4You! . This illustrates the palpable enthusiasm felt during the day and exemplifies the participatory environment in which youth were truly engaged.

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Another primary outcome emerged from the involvement of youth from the Regent Park Focus youth media centre. The youth journalists involved with the program actively ! participated in Food4You!, and documented the forum with still photography and participant interviews. The result will be a Food Security related issue of their quarterly publication Catch da Flava, a youth-developed " magazine, focusing on the Food4Health Initiative and the Food4You! experience. 2500 copies of the magazine will be available at 85 locations across the GTA, including local schools, community centres, bookshops and libraries. Although the short timeframe in which to develop and deliver a conference posed some limitations, the Food4You! event reached capacity and provided a unique opportunity for diverse groups to meet, share ideas, and develop or extend new networks that can promote further action on food systems health. Most importantly, Food4You! provided a clear example of ways to engage youth and provide them with an authentic means of voicing their concerns, proposing ideas, learning and self-organizing for further action.

1.3 4H Ontario Leadership Training & Evaluation In order to build capacity for rural youth engagement, Food4Health partnered with 4H Ontario to create an evaluation platform for their youth leadership programming. 4H Ontario has a long-standing history of providing leadership training to youth living in rural Ontario. Community members and organizations have acknowledged that these leadership programs have a meaningful impact on rural youth engagement, however there has been little formal evaluation conducted on such programs. Through their community partnership with the Youth Voices Research Group, 4H Ontario identified a need to perform an evaluation of their youth engagement programs and communicate the findings within and beyond their organization. The Food4Health team was invited to evaluate two separate 4H leadership campsâ&#x20AC;&#x201D;the Future Leaders in Action (FLIA) and the Greenbelt Youth Forum. The evaluations were designed to provide the first step towards a sustainable set of methods and tools that 4H could use for future programs and could administer by themselves to assess their ongoing youth engagement activities. In addition, the establishment of 4H Ontario as a community partner provided an avenue for future collaboration with other Food4Health partners. Outcomes The FLIA training incorporated a variety of different skills into the four-day leadership camp. Using the FLIA materials and discussion with the Opportunities Coordinator, the Food4Health evaluation team identified the areas of group facilitation, conflict resolution, communication, stress management, problem solving, time management, and general leadership skills as being central to the program. The development of both pre- and post-test surveys were based on an array of materials, such as those developed by the Kellogg foundation, prior 4H surveys and academic literature. Forty-seven youth participants were asked to rate their skills on a Likert scale of 1 to 5 where 1 was strongly disagree, 2 was disagree, 3 was neutral, 4 was agree, and 5 was strongly agree. Additionally, the survey included open ended questions and space for further comments.

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Data analysis using SPSS demonstrated a statistically significant increase in the average score of responses to the statement â&#x20AC;&#x153;I consider myself to be an effective leader.â&#x20AC;? Additionally, the average leadership score of all questions in the pre- and postleadership survey increased post- FLIA training. Overall statistical analysis demonstrated selfreported positive outcomes in all of the measured leadership skill areas. These positive results, coupled with quotes obtained in the open-ended questions, such as â&#x20AC;&#x153;I am going home with many new skills in my backpack to help out my local association,â&#x20AC;? highlight the value that FLIA youth attributed to the training program.

The 4H Greenbelt Youth Forum training program had a slightly different emphasis than that of the FLIA, focusing more on environmental stewardship and leadership values. A modified version of the first pre-and post-test survey was used to evaluate the impact of the Greenbelt Youth Forum on youth. The modified survey eliminated any content specific to the FLIA weekend, evaluating more general leadership skills. Next Steps Preliminary analysis of the FLIA evaluation demonstrates the positive influence of this training on 4H youthâ&#x20AC;&#x2122;s self-perceived leadership abilities. While these results indicate that FLIA is having a positive, immediate impact on self-perceived leadership skills, it would be beneficial to provide an evaluation of the long-term impact of the training program. A long-term follow up of these camps is necessary to determine how the skills in FLIA translate to leadership abilities in the community and other 4H initiatives. Ontario 4H is exploring ways to support continued, long-term evaluation follow-up with the Youth Voices Research Group. In addition to the promising results found in the FLIA evaluation, this endeavor has identified the potential for 4H Ontario to collaborate further with the Food 4 Health initiative and other - ,% % * community project partners. Community partners, $" & "! such as the Ontario Agri-Food Education (OAFE) and !" $" " $! & " 4H Ontario may benefit from future collaboration and sharing resources. Future steps must be taken to ! " " " strengthen these partnerships, should time and + & $" funding be made available. & ! # "

1.4 Growing Reflections, Understanding Bites The Growing Reflections, Understanding Bites (GRUB) toolkit was developed through a partnership between TakingITGlobal and the Youth Voices Research Group, with the purpose of supporting educators in bringing engaging discussions about food into learning environments. GRUB is a new and exciting interactive classroom looking at youth perspectives on food choices and food systems and provides a way to engage youth and teachers in health promotion using a combination of interactive electronic and printable materials. The GRUB toolkit features photographs and captions created by both rural and urban young people, to encourage your students to ask important questions about the food we eat, where it comes from, how we make our food choices, and how those choices affect our health. This resource also provides students with the opportunity to create their own reflections about food and health. As part of the $" ! ! $ ( $ " ( % ! "' " /.

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Food4Health initiative, the GRUB Toolkit was adapted for use within both traditional and virtual educational settings, by integrating both online and offline lesson plans and student activities. Outcomes The online revisions to the GRUB toolkit include suggested virtual activities such as blogging, online research and reporting on different topics from a local and global perspective, virtual games, participating in online chats and forums, learning about initiatives within their communities, researching and debating about different ways of getting involved with food issues, etc. Whenever applicable, examples and information from local initiatives and organizations were also provided. The sources for the background information, handouts and activities included the websites and/or publications of the following organizations and agencies involved in food issues:

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World Health Organization UNâ&#x20AC;&#x2122;s Food and Agriculture Organization The World Food Programme Public Health Agency of Canada Health Canada Heart and Stoke Foundation Eat Right Ontario & Dietitians of Canada

Next Steps The new format of the GRUB toolkit will undergo a review by consultants with Ontario Agri-Food Education (OAFE). The Toolkit will then be pilot tested in Ontario schools to explore the interest, applicability, and capacity for schools to use the GRUB virtual classroom Toolkit to promote health and wellness around food issues. The results of this implementation in virtual settings will also be evaluated through feedback obtained by TakingITGlobal. As a first step in the pilot testing of the GRUB Toolkit, Youth Voices Research Group was pleased to form a new collaborative relationship with New Outlook, a youth-serving organization part of Central Toronto Youth Services. New Outlook is the only program of its kind in Toronto that provides a wide variety of services to 15-24 year old young adults who are recovering from serious mental illness, primarily psychotic disorders. Programs are delivered from a holistic approach and support clients on their road to recovery by â&#x20AC;&#x153;providing best practice client-centered treatmentâ&#x20AC;?. Embedded within New Outlookâ&#x20AC;&#x2122;s service delivery is a day program that includes life and social skills training, recreation as well as academic studies in a structured and supportive environment. New Outlookâ&#x20AC;&#x2122;s day program currently serves 13 youth who welcomed the opportunity to more about food systems and food security in their own weekly Food & Nutrition class. Building on this teachable opportunity, a member of the Food4Health team facilitated a two-part workshop on food issues utilizing the GRUB Toolkit. After completing their sessions using the GRUB toolkit, all eleven participants indicated that they had gained new knowledge and understanding about food related issues. The majority of youth (10 out of 11) indicated that they had learned new skills , and nine also indicated that they were inspired to take action.

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The New Outlook pilot was an important â&#x20AC;&#x153;test driveâ&#x20AC;? of the newly revamped GRUB toolkit, and also signaled a promising emerging community partnership.

1.5 Ontario Agri-Food Education in the Classroom Ontario Agri-Food Education Inc. (OAFE), and their associates Green Thumbs Growing Kids (GTGK), were the key partners engaged in efforts to examine ways to engage youth through schools. OAFE was created in 1991 with the mission of building awareness and understanding of the importance of an agriculture and food system. The primary business of OAFE is to provide high quality, objective, and relevant agriculture and food related learning materials and services for Ontario educators to enhance the learning experiences of students in Ontario classrooms. The Food4Health initiative provided an opportunity to position these resources into a wider health promotion and public health context and enabled OAFE to create a school-centered workshop for teachers that would highlight the available curriculum-based agri-food resources the organization has available to educators and students, thereby increasing awareness of OAFE and the services it can offer. The workshop was piloted at two GTA schools, each reflecting a different demographic challenge:

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Lawrence Heights Middle School (Grades 6-8) for educators of all subjects

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University of Toronto School (Grades 9 â&#x20AC;&#x201C; 12) for course-specific educators, in the Geography & Social Studies Dept. and the Health and Physical Education Dept.

Lawrence Heights Middle School is located in one of the priority areas of need within the city of Toronto, while UTS focuses on students who have accelerated learning needs. This type of diversity enabled the Youth Voices Research Group to assess the degree to which the Food4Health approach and OAFE educational materials could reliably engage diverse student bodies in different contexts. Outcomes Overall response from teachers attending the OAFE workshop was extremely positive. All attendees were impressed with the abundance of materials provided to them and were excited to learn of the unique ways in which agri-food education could be brought to their students in all subject areas via multiple teaching styles. Follow-up with the teachers suggested that they found the opportunities to engage students in food systems-related health promotion to be high and expressed a high degree of interest with the Food4Health mission and satisfaction with the OAFE materials. Next Steps Future recommendations include the provision for a follow-up to determine whether or not teachers have used the newly acquired OAFE resources, and if so, to what extent. It would also be beneficial to evaluate this workshop model at additional schools to see if it could be improved upon or modified for greatest uptake. Through OAFE, a new partnership was also established with Green Thumbs Growing Kids (GTGK). The GTGK mission is to teach urban children and their families to grow and appreciate fresh, nutritious foods, grown in an environmentally sustainable and socially just manner, through hands-on programming. This year GTGK worked with #$

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hundreds of students and community members through their programs and projects. The Food4Health initiative was able to work with GTGK to create a sustainable evaluation tool for use with student and teacher participants, to best inform the organization from all aspects of involvement and perspective. Implementation of the GTGK evaluation will be taking place in June 2009 and November 2009 to reflect both their Spring and Fall programs.

2. Research and Evaluation The research and knowledge translation activities focused on synthesizing existing knowledge of youth engagement, evaluation, and partnership development. The goal of these activities were to bring together the best evidence and tools currently available to both inform the community of practice forming through Food4Health and the Ministry of Health Promotion and to guide the future development of a sustainable, longer-term strategy to build on the networks created through this project (Phase 2). 2.1 Review of Current Engagement & Evaluation Practices in Ontario In an effort to contribute to knowledge translation and exchange in the domain of youth engagement and health promotion, an environmental scan was conducted of current practices for evaluating youth engagement in health promotion. The environmental scan began by contacting key research units and youth-serving organizations identified by the Food4Health PI and research coordinators. Additional organizations with youth programs were identified through the Ontario Health Promotion Resource System, TakingITGlobalâ&#x20AC;&#x2122;s 2006 report on youth engagement across Canada, and personal knowledge of youth-focused initiatives underway in the province. Web searches were also conducted to identify publicly available evaluation tools developed and/or used by organizations in Ontario.

A total of 54 organizations were contacted, and information was collected from 13 organizations. It is not clear why the participation rate was so low; It may be timing (i.e., the scan was conducted during â&#x20AC;&#x2DC;year endâ&#x20AC;&#x2122; which is a busy time for organizations), or reluctance to freely share resources, or fear of judgment. In an attempt to increase participation, it was determined that an adjusted â&#x20AC;&#x2DC;askâ&#x20AC;&#x2122; would be helpful. The adjusted ask included the following questions: â&#x20AC;˘

How do you involve youth in your programs?

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Do you evaluate your programs?

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What do you evaluate? (e.g., youth engagement, health projects or outcomes, social action projects or outcomes)

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How do you evaluate? (e.g., surveys, debriefs, interviews, etc.)

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Would you be willing to share your evaluation tools or tell us more about them? If so, can we include tools or only a description of them in the report? #$

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Findings The following points are key findings that emerged from the environmental scan: â&#x20AC;˘

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There are significant variations in the evaluation capacity among organizations who work with youth: â&#x20AC;˘

Large-scale and well-funded initiatives tended to have a formalized evaluation model informed by a â&#x20AC;&#x2DC;theory of youth engagementâ&#x20AC;&#x2122; and expert researchers - often university-based research teams.

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These evaluation models often included academic concepts in their indicators and rely on validated measurement scales.

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Community-based organizations tended to have informal evaluation processes, highlighting the challenge that limited financial and technical resources pose for community groups in relation to designing, conducting, and acting upon evaluative research.

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Evaluation processes need to be meaningful, useful, and doable for organizations with limited capacity.

The focus of evaluation in youth health promotion programs generally does not focus on the process of achieving â&#x20AC;&#x2DC;youth engagementâ&#x20AC;&#x2122; - as defined in the systematic review (i.e., higher levels of Hartâ&#x20AC;&#x2122;s ladder) â&#x20AC;&#x201C; nor the individual and social outcomes resulting from such engagement. Rather, the most common types of indicators include:

a. Number of youth participants and/or frequency of participation. b. Changes in knowledge and skills related to workshops and training

programs among engaged youth. This primarily focuses on the knowledge and skills required to successfully act as peer educators/ leaders (e.g., technical knowledge of tobacco products and their health risks, how to advocate, etc.).

c. Health-related attitudes and behaviors. â&#x20AC;˘

Some organizations measured youth participantsâ&#x20AC;&#x2122; experience of the organizationâ&#x20AC;&#x2122;s youth engagement processes. For example, what the youth liked/ disliked about their experience, what they gained through their experience (knowledge, skills, connections, etc.), how they felt about their group (e.g., sense of belonging, group dynamic, group decision-making, etc) how adults and youth were involved in programmatic and organizational decision-making, and what organizations can do to better engage youth.

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A very limited number of organizations â&#x20AC;&#x201C; those that either fund or promote youth engagement - also have tools to assess/evaluate organizational readiness and the experience of adults working with youth. The Laidlaw Foundation, for example, includes questions about where/how youth are involved in the organization, attitudes/beliefs of adult leaders, perceived benefits of youth engagement, and training needs.

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Few organizations included indicators measuring the impact of youth engagement on other young people or the young peopleâ&#x20AC;&#x2122;s communities (perceived or real). For example:

Ontario Tobacco Research Unitâ&#x20AC;&#x2122;s evaluation of the Youth Action Alliance asked engaged youth questions such as their perceived ability to influence change and decision-making in their community and perceived #$

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level of empowerment as a social change agent.

The Newcomer Orientation Week (NOW) program evaluation plan includes indicators to assess whether and how participation in this program influences the adjustment of newcomer youth (e.g., common teaching and learning approaches, engagement in extra-curricular activities, development of a social network, help-seeking behaviours, etc.), through the perceptions of adults (i.e., teachers, support workers, principals), participating newcomer youth, and a comparison group.

Organizations & Agencies Included in the Scan: â&#x20AC;˘

Centre for Behavioural Research and Program Evaluation â&#x20AC;&#x201C; School Health Action, Planning, Evaluation System (SHAPES)

â&#x20AC;˘

Childrenâ&#x20AC;&#x2122;s Hospital of Eastern Ontario â&#x20AC;&#x201C; YouthNet

â&#x20AC;˘

First Nations Child and Family Caring Society of Canada

â&#x20AC;˘

Juvenile Diabetes Research Foundation

â&#x20AC;˘

Laidlaw Foundation â&#x20AC;&#x201C; Youth Program

â&#x20AC;˘

Newcomer Orientation Week

â&#x20AC;˘

Ontario Tobacco Research Unit

â&#x20AC;˘

Physical and Health Education Canada

â&#x20AC;˘

Provincial Office of the Advocate for Children and Youth

â&#x20AC;˘

Public Health Agency of Canada

â&#x20AC;˘

Rainy River District Substance Abuse Prevention Team (FOCUS project)

â&#x20AC;˘

TakingITGlobal/McConnell Foundation

â&#x20AC;˘

The New Mentality

â&#x20AC;˘

Youth Advocacy Training Institute, Lung Association

2.2 Systematic Literature Review: Youth Engagement and Health Young people have a right to assert their voice and control in decision-making processes that affect their lives (United Nations Convention on the Rights of the Child, 1997). Youth engagement is a broad term that refers to a model of practice used to facilitate young peopleâ&#x20AC;&#x2122;s capacity to exercise this right. In practice, youth engagement is understood as the meaningful, respectful and sustained participation of a young person in an activity that has a focus outside of him/herself (The Centre of Excellence for Youth Engagement (TCEYE), 2003). Roger Hartâ&#x20AC;&#x2122;s Ladder of Youth Participation (see Figure 1) summarizes the spectrum of #%

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how youth participation typically occurs in initiatives (The Freechild Project, 2008). For the purposes of this review, youth engagement, as described above, is characterized by rungs 6 to 8 of the Ladder. Any activities that did not fit these levels of involvement were excluded from the review. Youth engagement is widely regarded as a process that contributes positively to young peopleâ&#x20AC;&#x2122;s:

â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

Development of life skills (e.g. leadership, critical thinking, consensus building, problem solving) Self-esteem, self-confidence, resilience Sense of belonging in their immediate and broader communities Relationships and connectedness with their peers, family and communities (TCEYE, 2003)

Moreover, it is used as a means to reduce the impact of the social determinants of health, including poverty, poor mental health and discrimination, that make youth particularly vulnerable to violence, risk behavior and poor health outcomes (McMurtry & Curling, 2008). With these perceived advantages, youth engagement is becoming an increasingly popular model of youth participation within academia. Findings The systematic review provided an opportunity to summarize the peer-reviewed academic literature that has demonstrated a relationship between youth engagement, health promotion, and the health and wellbeing of young people and their communities. The review was initiated through the Food4Health project and due to the scope of field, the results presented here reflect an initial summary based on an initial systematic search, retrieval and sort of the literature, but not a finished synthesis. The findings from this review will provide an evidence-based source of analysis and recommendations to guide the role of youth engagement in public health and health promotion initiatives, practice, and research. Seven academic electronic databases 1 were searched for articles published in peerreviewed journals since 1995. Search terms drawing upon concepts of youth empowerment, leadership, action, and engagement with respect to health and wellbeing, as defined by the World Health Organization (1946)2, were utilized. Youth were defined as persons aged 12 to 30. Interventions must have demonstrated levels 6, 7 or 8 on Hartâ&#x20AC;&#x2122;s Ladder of Participation. The 1969 citations generated from the search were refined through a manual review of each article at the abstract-level (resulting in 160 citations). Ongoing review at the article-level has resulted in 26 citations that will be included in final collation and analysis. The following findings are based on our preliminary review of the literature at the articlelevel. Detailed results and analysis will be reported upon completion of the systematic review: A. Youth engagement in practice 1Electronic

databases searched in March 2009: Web of Science, Scopus Sociological Abstracts, ERIC, CINAHL, MEDLINE and PsycINFO

â&#x20AC;&#x153;Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmityâ&#x20AC;? #%

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Youth were engaged in a variety of participatory roles and through a number of mediums of which the majority were adult-led and/or initiated (Rung 6 of Hartâ&#x20AC;&#x2122;s Ladder). These forms of engagement were commonly used synchronously within a single initiative:

â&#x20AC;˘ â&#x20AC;˘ â&#x20AC;˘

Peer leadership: Youth, with the support and/or involvement of adults, actively engaged in decision-making, organizing, advocating, facilitating, planning, and/ or implementing around issues, ideas, and programs for their peer community Participatory action research (PAR) â&#x20AC;&#x201C; Youth engaged as active co-researchers with adults in developing, guiding, and conducting research on issues pertinent to their lives as young people Peer education â&#x20AC;&#x201C; Education and/or outreach provided by trained youth to their peers

Arts-based approaches (e.g., Photovoice, film-making, and theatre) stood out as popular means by which to engage youth in identifying, addressing, and acting on the underlying social determinants of health affecting their lives. Additionally, arts were sometimes utilized as a mechanism to facilitate engagement of youth by youth (e.g., through youth-led forum theatre). Projects were often initiated in school environments, as both curriculum-based and extra-curricular programming, as well as within community settings (e.g., communitybased and/or social service organizations). B. Youth engagement and health Initiatives often endeavoured to affect young peopleâ&#x20AC;&#x2122;s behaviours, attitudes, skills, and knowledge, particularly in relation to disease prevention and/or risk reduction. These initiatives tended to focus on substance use/abuse (e.g., alcohol, tobacco, narcotics) and sexual activity/risk (e.g., sexually transmitted infections, particularly HIV/AIDS). Initiatives sometimes took a broader approach to health and wellbeing by engaging youth in health promotion, community development, and capacity-building processes. In these instances, it appeared that young people were effective as agents of change in the health of their peers and communities. While the majority of articles reported health and wellbeing outcomes for engaged youth (e.g., peer educators), some also reported outcomes for youth engaged by youth (e.g., studentsâ&#x20AC;&#x2122; behaviour change following a peer education intervention). C. Recommendations Increase the focus on youth engagement for long-term positive health and wellbeing thereby supporting a more holistic and proactive approach to healthy youth development (e.g., investing in healthy sexuality initiatives as opposed to programming exclusively focused on STI risk reduction)

Take a socially inclusive approach to youth engagement: o Use targeted recruitment strategies to ensure that youth who are being engaged proportionately reflect Ontarioâ&#x20AC;&#x2122;s diversity, particularly those whom identify with historically marginalized groups (e.g., Aboriginal youth, differently abled youth, racialized youth, LGBTQ youth) o Provide a broad range of initiatives that will accommodate and reach the greatest variety of youth (e.g., consideration given to issues of literacy, learning styles, â&#x20AC;&#x153;safeâ&#x20AC;? youth spaces, etc.) #%

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Youth engagement, at its best, occurs from start to finish. Consequently, youth should be engaged in: o Development and decision-making processes of programs/projects, particularly those from which they are traditionally excluded, such as writing or approving application and funding proposals oIdentifying their own health priorities; this participatory approach aligns strongly with best practices in health promotion planning Provide resources and support for youth-initiated projects as well as opportunities for youth to work in equal partnership with adults Conduct an environmental scan, including a grey literature review, on youth engagement initiatives for health occurring within community settings as initiatives borne from grassroots and communitybased organizations tend to have limited access to the academic partnerships and/ or financial and human resources necessary for academic publication

2.3 Systematic Review on Public-Private Partnerships for Public Health A systems-oriented approach to health promotion requires involvement of actors that reflect the systemsâ&#x20AC;&#x2122; diversity. In food systems and youth engagement, this means involving private, public, and non-governmental groups in addition to youth in the process. Although much of heath promotion is focused on the non-governmental, public or citizen aspects, there is relatively little knowledge on how to further engage the private sector in respectful, appropriate and productive ways as members of society in contributing to solutions to health problems. This review seeks to understand this phenomenon in terms of the scientific literature as a means of guiding further partnership activities in health promotion. The goal of this systematic review is to understand the models and components of private-public partnerships (PPPs) and the critical elements that could contribute to the success or failure of this kind of approach, and in particular, issues related to governance. Methodology and preliminary search results Based on a preliminary literature review, a protocol was developed which outlined the methodology used to systematically search for and analyze the best available evidence on PPPs.1 The search strategy was divided into three steps: (i) search of peer-review journals indexed by 10 databases, including MEDLINE, EMBASE and eight other databases; (ii) hand search of the reference list of key articles, (iii) contact with authors of eligible articles and colleagues to identify any relevant studies that might have been missed. This report reflects the findings of the first search strategy, with 100 articles selected for full-text review and 38 of these meeting the inclusion criteria for the systematic review. Thus, the results discussed in this document are partial. The analysis was focused on governance-related issues of empirical public-private partnerships for public health. Critical factors related to governance in different stages of the PPP were then identified: formation, coordination & management, operation and sustainability.

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(See Appendix: Table 1 for an overview of governance-related issues identified in key empirically-based articles). Findings Promoting PPP requires careful thinking and planning from its formation to its operation and sustainability. Governance issues have shown to be critical as PPPs embrace some complex organizational arrangements and ethical aspects. Key lessons learned from this systematic review are identified below:

A. Formation

In the formation stage of PPPs, a number of essential considerations arose from the literature. The criteria for selecting partners in terms of competence and appropriateness, the need to recognize motivations and take into consideration all partnersâ&#x20AC;&#x2122; interests, the definition of roles and objectives and the compliancy of shared risks were consistent across the literature. In some cases, legal agreements of research objectives, publication of results and intellectual rights were fundamental for the success of the initiative. The role of strong leaders, and commitment from all partners were key. Trust among partners (the public sector and private health providers) was also an important issue to overcome. In areas where public health service was fragmented or weak, intense dialogue and communication were required in order to build trust. Successful partnerships for strengthening health services delivery (i.e., access and treatment of TB) required a highly involved and committed public sector. In the partnership for product distribution and access, the legitimate participation of local authorities and participatory decision-making process were recognized as vital for the accountability of the initiative, as they relate to inclusiveness and perceived ownership.

B. Coordination & Management

The majority of the initiatives indicated the necessity of having a platform for regular communication with partners, clear management guidelines and less-complicated management mechanisms, a strategy for knowledge translation between researchers and policy-makers, and an active involvement of high government authority. In this stage, the person or group who acts as liaison should have the ability to deal with and resolve conflicting agendas, as well as to leverage the strengths of partners. In partnerships for product distribution and access, transparency in terms of scientific, economic and policy issues related to the initiative was required among all partners. Distorted power relations, in particular among those partners with greater economic power, might impede the development of a successful partnership.

C. Operations

Building a strong scientific capacity of local researchers and partnering with stakeholders who have operational expertise were found to be essential in this stage. In product development partnerships (R&D), the operational arrangement was based on the business model approach (i.e. venture capital) to investing in product research and development. Rather than partnering with a single corporation, this type of initiative often interacted with many companies through competitive funding proposals. In the cases of strengthening health services, important operational constraints were adequate infrastructure (e.g. training staff, logistics, capacity) and overburdened public health staff. Regulations were seen as an important asset in overcoming health care service fragmentation.

D. Sustainability

Promoting local ownership and encouraging other organizations to participate was suggested as a strategy to promote sustainability. In partnerships with a strong #%

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international leadership, transferring external roles to local governments was a question of long-term sustainability. Furthermore, the availability of adequate resources and continuity in leadership were identified as key sustainability factors.

E. Governance structure

The governance structure varies according to the nature of the partnership (i.e. product development, product distribution, health service delivery), the location of the initiative (global, national or local), and the initiator (government or private sector). In fact, the findings of this review indicated that there is no one appropriate governance structure or ideal model: each partnership should be developed based on its own context and goals, and preserve an iterative process. Some PPPs have created separate not-forprofit organizations to run the project, with independent fiduciary responsibilities. Several initiatives developed similar governance structures, consisting of a scientific advisory committee, a principal investigator or office liaison, and steering committee. In the case of partnerships for strengthening health services, the scientific advisory committee was often formed by academic researchers with no financial interest in outcomes of the partnership. These committees advise and assist the PI and act as a buffer between the PI and any corporate financial supporters. In partnerships related to product development and distribution, the scientific committee consisted of representatives of international organizations (e.g. WHO), international NGOs (created to run the initiative), and representatives from the private sector. However, this structure has been criticized for its lack of participatory mechanisms for local researchers and representatives from local government. For example, in one PPP, the steering committee consisted of members of the scientific committee and representatives of the corporations, and had a role in defining protocols, managing records, and linking corporations with supporting community organizations and projects. In an example of a partnership for product development, an NGO was created to operate the project, a director was hired and a small management team oversaw the ongoing activities, and a flexible operation system was preserved. In other cases, a working group committee was formed to develop strategies that would be acceptable to all partners. This working group consisted of high-level government authorities, local health officers, representatives from the private sector, representatives from the local NGOs and members of the research team. The concluding message is that in order for PPPs to be effective, a well-defined governance structure with clear and agreed roles and responsibilities of the all partnersâ&#x20AC;&#x2122; involved is required.

2.4 Food4Health Evaluation Model The Food4Health program involved our research team (n = 16) to work with a plethora of community organizations, youths, donors and academics with the purpose of program development and evaluation. However, the broad range of activities involved in youth engagement work (as exemplified through Food4Health, reflecting a microcosm of the youth engagement field) at the same time and by different team members, fragmentation existed between program goals, definitions and evaluation processes. Thus, a working Food4Health research group was created to develop a common approach to designing and evaluating youth engagement programs that could take lessons learned from this diversity and convert it into practical and scientific value for health promotion work.

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Consultations began with program coordinators and research leads on each subproject to identify and discuss program goals, key definitions, and evaluation strategies. Following these discussions, literature was reviewed for methods and scales for measuring youth engagement, health literacy, leadership, and community participation. Stemming from this review, the evaluation team decided that two main program outcomes would form the overall objectives of the initial Food 4 Health programs: (a) health literacy and (b) youth engagement. Key theories were used as guidelines for the design and evaluation of materials related to the two outcomes, including UNESCOâ&#x20AC;&#x2122;s Four Pillars of Education, Freireâ&#x20AC;&#x2122;s Critical Literacy Model, Nutbeamâ&#x20AC;&#x2122;s Health Literacy Model and Bloomâ&#x20AC;&#x2122;s Educational Taxonomy. Many of these models indicated that educational approaches and youth program participation take on a multi-layered form. Layers range from knowledge translation to action (figure 1 & 2). Therefore, successful evaluation strategies needed to capture the complex nature of education and youth participation. The literature further illustrated that outcomes were typically evaluated using qualitative methods, thus creating a barrier for survey-based evaluation strategies. To further strengthen the evaluation model, key definitions were highlighted, including food security, nutrition and empowerment. These terms were commonly used throughout Food4Health initiatives, yet no uniform definition existed. Based on the initial procedures, several steps were taken to design program and evaluation materials: First, using the Food4Health Wiki (a collaborative, web-based tool for writing), key definitions were determined based on the literature and suggested by members of the team. It is important to note that each definition had a multitude of interpretations. As a result, a participatory approach to determining key definitions was used. During the Food4Health dissemination conference stakeholders, community organizations and funders were asked to provide their interpretations of the key definitions. Through the participatory feedback and the literature search, definitions for the key terms were compiled. These definitions will now serve as benchmark terms for Food4Health. Second, using the theories found during the literature review, scales were developed to measure the outcomes from two perspectives: a) the educational and facilitator side and b) the participant side. Each scale accounted for the multiple layers of education and participation. Four levels were created and each level was accompanied by a specific criteria. Moreover, a qualitative assessment was used. This process involved a subjective evaluation of the extent a program satisfied the specific criteria. Even though a scale was used, each number on the scale was not matched to a predefined category. Participants were encouraged to evaluate a program based on their subjective experience. Third in order to present the findings of the assessment a spidergram was used. Spidergrams provide a visualization of youth engagement and health literacy produced by a specific Food4Health program. There are several benefits of using this assessment tool. First, it may show how change has taken place in a program and why. Second, it also examines participation as a process rather than an outcome. Using the scales, spidergrams were created for the two perspectives. Each level of education and participation represented a spoke on the spidergram (Figure 1 & 2). Finally, evaluations were administered on two occasions. First, on the education side, the evaluations were administered following the OAFE presentation to the University of Toronto Schools. Four participants filled out the survey and a spidergram was created. $#

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Second, on the participant side, the evaluations were administered following the Food 4 Health un-conference. 47 participants completed the survey. Outcomes Overall, the two programs that were evaluated had very broad spidergrams, indicating that both the OAFE presentation and the un-conference were successful in promoting health literacy and youth engagement. It is important to note that both of these groups of respondents were highly engaged. This may have positively influenced the results of the spidergram. Next Steps Several future directions can be implemented for this evaluation model. Key directions are highlighted in the list below: â&#x20AC;˘ Key definitions can be further defined - this will involve further participatory feedback and will allow Food4Health to create well-defined, collaborative definitions that incorporate a wide-range of interpretations. â&#x20AC;˘ Qualitative measurement scales can be refined - this would involve a further review of the criteria and a discussion on the qualitative methodology used. â&#x20AC;˘ Evaluation materials can be applied and tailored to future Food4Health projects - this will allow for a deeper understanding of the generalizability of the measurement scale. This step should be conducted with participants who may not be highly engaged at baseline to gain a better understanding of the use of the evaluation tools. â&#x20AC;˘ Further testing of the measurement properties of the qualitative assessment should be conducted - this will include examining the reliability, sensibility and validity of the scale.

Figure 2: Blank spidergram, from the educational side. This evaluation tool is meant to be utilized by program facilitators to measure health literacy and youth engagement that is produced from their program.

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Figure 3: Blank spidergram, from the participant side. This evaluation tool is meant to be utilized by participants to measure health literacy and youth engagement that is produced from a program.

3. Knowledge Translation Another principal goal of the Food4Health initiative was to develop a sustainable knowledge translation platform that could extend beyond the life of the project if necessary and serve to shorten the distance between the development of new knowledge and the dissemination of that knowledge to the wider community. These goals were achieved through multiple means: 1. Social Media 2. Partnership development 3. Public events 4. Promotional materials

3.1 Social Media Social media refers to a class of electronic tools that enable a dialogical means for creating, editing, and distributing content. For Food4Health, this involved three core tools: 1) Project pages on TakingITGlobal, 2) Facebook, and 3) Twitter. TakingITGlobal has developed a project communication platform via its website that enables groups to post content such as documents, blogs, and aggregate feeds from other sources onto one project-specific website. For this project we developed two specific sites, one for the overall project (http://projects.tigweb.org/food4health) and #$

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one for the Food4You! unconference (http://projects.tigweb.org/foodsecurity4-U). Food4Health team members blogged on each of these sites and encouraged other members of the TakingITGlobal community and those youth involved with the various projects to participate in the sites. Although there were thousands of hits on the sites, contributions to the site by non-Food4Health staff were few. Nonetheless, the main Food4Health project page drew over 1400 unique visitors (and thousands of page views) in less than 8 weeks with relatively little promotion of the site outside of direct communiques with partners. With more than 155 blog posts generated in 8 weeks, this represents an innovation in social engagement with the public and an unprecedented knowledge translation opportunity. With more time to prepare a dissemination plan for the site it is not unreasonable that this could serve as a vehicle for informing or engaging tens of thousands of young people. The content of the blogs included reflections on the activities, information sharing about local food-related events or news stories, or communication about the latest scientific research on youth, food and health. A Facebook group was established to communicate events and enlist participation from the community (http://www.facebook.com/group.php?gid=52659497519). Even though promotion of the site was minimal due to time, 55 people still found and signed up as members of the group. It is not known how many visitors came to the site, however given the relative effort required to sign up a a group member, it is likely that this number was high. Lastly, Twitter, a â&#x20AC;&#x2DC;micro-bloggingâ&#x20AC;&#x2122; tool that enables people to share information via multiple platforms (e.g., wireless phone, Internet, third-party programs) was utilized as a means of communication. Three Twitter feeds were established, with all primary activity circulated through the @Food4Health account. Like Facebook, we are unable to determine the number of readers, however more than 75 people had signed up to â&#x20AC;&#x2DC;followâ&#x20AC;&#x2122; the feeds from this account. The Youth Voices Research Group Principal Investigator (who had more than 80 followers) and many of the Food4Health team members also blogged about the project through their respective accounts.

3.2 Partnership Development Another principal goal related to knowledge translation was to provide linkage and exchange opportunities between members of our Food4Health community. Through the Food4You! and Food4Health unconference events, members of diverse communities were brought together to network and meet. In addition, active facilitation of partnerships was done by members of the Food4Health team to ensure that groups with common interests who did not know one another either met or were introduced via email or some other method. This resulted in many new connections between groups with similar mandates, but working in different sectors, regions or with different methods. A review of the project suggested that this sustainability-first social networking model was much appreciated by the participants and that it produced new opportunities that will be realized beyond the first phase of Food4Health. A second method of partnership development was initiated and that is through data sharing. An

initial,

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easily accessible, data sharing platform was developed for this project to enable future Food4Health and related engagement projects to share not only prepared documents and visual media, but data reports. This platform will enable partners to download summaries of evaluations performed not only on their own projects, but also those of all the other partners involved in the Food4Health initiative (subject to authorization and approval). This has also been designed to enable community groups to perform some types of data analysis on their own without the need for complex statistical support. This is not designed to replace evaluators or statisticians, but rather lessen community groupsâ&#x20AC;&#x2122; reliance on third-party or (in certain cases) in-house statistical support.

3.3. Public Events Three major Food4Health events were held to both disseminate and communicate as well as collect information from the public. The first event, the Food4You! unconference described earlier, was held on April 21st at Hart House at the University of Toronto. The focus here was on engaging a wide-range of groups, particularly youth, to learn of their needs and ideas, to foster networking, and to communicate about the project. The second was held April 22nd at the Health Sciences Building at the University of Toronto and was designed to disseminate the preliminary findings of the project and outline the Food4Health project in general to the professional/practice, academic and policy sectors. The event was attended by nearly 50 people who represented a cross-section of audiences and led to many new opportunities for further engagement. The event was video recorded and will be posted in various forms on the World Wide Web through the Youth Voices Research Groupâ&#x20AC;&#x2122;s websites and tools like YouTube. The third event was held on April 29th at the Toronto Free Gallery and was aimed at wider communication with the public, particularly youth. The event featured demonstrations, media presentations, and locally-sourced food to showcase the activities that were done as part of the project with members of the public and answer questions. In addition to these events, members of the Food4Health team attended a series of events aimed at either youth engagement or food systems to both learn and network with other agencies in support of partnership development and knowledge translation. These included: a. The Ontario Test Kitchen conference from April 19 - 20th in Toronto b. Towards 2020 National Conference on Youth from April 26-29 in Ottawa Further dissemination will take place at the Global Youth Assembly in Edmonton, AB in August. 3.4 Promotional Materials The project timelines provided some challenges regarding reach and appropriateness of communications. Most of the materials generated were distributed through the Internet, however the face-to-face events and networking activities also provided an opportunity to communicate and promote the Food4Health initiative in novel ways. Consistent with the emphasis on food, sustainability, and health, locally-made, organic cotton lunchbags were made to distribute at Food4Health events. Included in the bag was also a pen with a body made entirely of corn (thus, it is fully biodegradable) with the project website on it and a seed that can grow once the used pen is â&#x20AC;&#x2DC;plantedâ&#x20AC;&#x2122; for degradation. Youth have consistently told the Youth Voices Research Group that colour is an important component of communications, thus colourful cards were distributed to partners and posted throughout organizations affiliated with the project to advertise the project or events like Food4You! (see Figure 4)

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4. Concluding Remarks Youth Leaders: Food4Health established an innovation cluster aimed at supporting health promotion in Ontario. From its design, its focus on systems, and the mechanisms for engagement, the Food4Health initiative sought to provide proof-of-concept on new models for health promotion, youth engagement and cross-sectoral partnerships that could be translated to areas beyond food systems and support a wide-scale chronic disease support platform. To this end, we believe that the project was an overwhelming success. Limitations & Opportunities The 10-week timeline in which to complete the entire project -- from staff hiring to project evaluation -- provided a limitation to the exposure of Food4Health, the sophistication and depth of the evaluation that was done, the range of partners that could be engaged (including youth) and the completeness of the findings. Nonetheless, the short timeframe also offered unprecedented opportunities for innovation and to test new models of operating within a networked model of health promotion on top of the other layers of innovation. To understand the impact of this project, we undertook an internal evaluation of the entire process and outcome using a series of in-depth interviews with core partners and each member of the team. This by itself can provide guidance to other Ontario groups on how to deliver innovative health promotion programs. In addition to providing evidence for youth engagement approaches, and laying a foundation for an evidence-informed, innovative set of models for health promotion, the Food4Health project has build a nascent community of practice at the nexus of public health, education, technology and agrifood. The opportunities to further leverage this network are many. This project has focused not only on youth engagement today, but laid a foundation for future development with the ongoing systematic reviews, database platform, and web of relationships -- new connections -- that have been formed. The Youth Voices Research Group is positioned to serve to lead to mobilize and extend this network for further systems-level health promotion across sectors. Through the detailed evaluations conducted through Food4Health and the collection & development of new tools, the Youth Voices Research Group is also positioned to provide strategic, tactical, research and knowledge translation support to other organizations across the health promotion spectrum. Funding for a second phase of Food4Health will provide the means to capitalize on these opportunities if done in a timely manner. An Engaged, Healthy Future Youth and youth-serving agencies exist in a highly dynamic environment due to rapid changes in service demands, the constant change in populations due to youth â&#x20AC;&#x2DC;aging outâ&#x20AC;&#x2122; while children â&#x20AC;&#x2DC;age inâ&#x20AC;&#x2122; -- all bringing needs, skills, and opportunities. Through creating opportunities that work with rather than against this dynamic current using tools (e.g., Facebook), topics (food and its myriad related issues), and strategies (respectful youth-adult partnerships) supported by the community, the potential to create a healthy, prosperous, and creative population can be realized.

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Acknowledgements YouthLeaders: Food4Health was a collaborative effort from its conception through to the development of this report. It is due to the efforts of the entire team and our community, academic, and technical partners that this project was possible. The team membership is listed below: Scientific & Program Leadership Cameron Norman, Principal Investigator Rob McLaughlin, Co-Investigator (Agrifood leadership) Alex Jadad, Co-Investigator (Healthcare & Technology leadership) Operations Management & Coordination Charlotte Lombardo, Youth Voices Research Group Manager Jill Charnaw-Burger, Food4Health Project Coordinator Project Staff and Consultants Marc Arseneau, Rural Engagement Co-Lead Ross Barker, Technical Services & Development Lead Andrea Cortinois, Multicultural Engagement & eHealth Promotion Advisor Monika Goodluck, Youth Engagement Systematic Review Co-Lead Arif Jetha, Evaluation Review Lead, Schools & Food Team Elizabeth King, Private-Public Partnerships Systematic Review Co-Lead Monica Nunes, Stomach This! Lead Lia de Pauw, Evaluation Review & Meta-evaluation Lead Jessica Patterson, Rural Engagement Co-Lead Maira Perotto, GRUB Toolkit Lead, School & Food Team Katia de Pinho Campos, Private Public Partnerships Systematic Review Lead Samy Ramez Saad, Food4You! Co-Lead Richard Steiner, Food4You! Co-Lead Michelle Tressler, Meta-Evaluation Design Lead Kora Stephenson, Research & Planning Assistance Andrea Yip, Youth Engagement Systematic Review Co-Lead Administrative Support Vanessa Anievas, Dalla Lana School of Public Health Svjetlana Kovacevic, Centre for Global eHealth Innovation Ann Murray, Centre for Global eHealth Innovation Airie Santiago, Dalla Lana School of Public Health Danny Lopez, Dalla Lana School of Public Health For more information about the Youth Voices Research Group or Food4Health contact: Cameron D. Norman, PhD Principal Investigator, Youth Voices Research Group & Assistant Professor, Dalla Lana School of Public Health, University of Toronto 155 College Street, Room 586 Toronto, ON M5B2P7 Canada +1.416.978.1242 cameron.norman@utoronto.ca

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Works Cited Bloom, S. (1956). Taxonomy of Educational Objectives. The Classification of Educational Goals. Pp 201-207. Susan Fauer Company. Freire, P. (2005). Education for Critical Conciousness. New York. Continuum International Publishing Group. Hart, R. (1992). Childrenâ&#x20AC;&#x2122;s Participation from Tokenism to Citizenship. Florence: UNICEF Innocenti Research Centre. McMurtry, R., & Curling, A. (2008). The review of the roots of youth violence. Toronto, ON: Government of Ontario. Nutbeam, D. (2006). Health Literacy as a Public Health Goal: A Challenge for Contemporary Health Education and Communication Strategies in the 21st Century. Health Promotion International, 15(3), 259-267. Office of the United Nations High Commissioner for Human Rights. (1997). Convention on the Rights of the Child Retrieved May 14, 2009, from http://www.unhchr.ch/ html/menu3/b/k2crc.htm Rifkin, S.B. Muller, F. & Bichmann, W. (1988). Primary Health Care: On Measuring Participation. Social Science and Medicine, 26(9), 931-940. The Centre of Excellence for Youth Engagement. (2003). Youth engagement and health outcomes: Is there a link? : Centres of Excellence for Children's Well-Being. The Freechild Project. (2008). Ladder of Participation Retrieved March 24, 2009, from http://www.freechild.org/ladder.htm United Nations Educational, Scientific and Cultural Organization (2009). The Four Pillars of Education. Accessed on April 19, 2009 at www.unesco.org/delors/fourpil.htm. World Health Organization (1946). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

Food4Health: A Youth Leadership Project for Health Promotion Executive Summary Food is positioned at a nexus of personal, social, economic and environmental health and provides myriad opportunities to engage youth in health promotion. The Youth Leaders: Food4Health initiative sought to leverage this opportunity with social media tools and robust partnerships involving change-leading organizations in agrifood, health, education, and technology. The objective was to connect youth and youth-serving organizations together to provide evaluation, networking and coordination support for a systems-oriented strategy to transform our food system and stimulate world-leading health promotion and chronic disease prevention innovation. The initiative focused on three key areas: 1) Community action projects, 2) Research & Evaluation, and 3) Knowledge Translation. Community Action Projects: Pilot projects aimed at understanding engagement in a naturalistic setting were developed with community partners. These projects were evaluated and supported with health promotion & evaluation staff from the Youth Voices Research Group. Stomach This! used a popular education model to help train youth to be activated leaders on issues of food security on college & university campuses. Ontario 4H also used the train-thetrainer approach in different ways with two other events aimed at rural youth engagement. School-based health promotion was the focus of efforts to connect learning leaders Ontario Agrifood Education with schools to explore novel ways to engage youth in schools. An electronic agrifood & health classroom was also developed in partnership with TakingITGlobal. Lastly, diverse youth and youth-serving agencies across the spectrum of food systems gathered for a one-day â&#x20AC;&#x2DC;unconferenceâ&#x20AC;&#x2122; that identified needs, opportunities and generated ideas and partnership opportunities for further action. Research & Evaluation: Three core research and evaluation projects provided insight into the general field of youth engagement and how to proceed with a strategy that engages diverse communities of interest. A systematic review of youth engagement initiatives on health was initiated, and concluded that peer leadership, education, participatory action research, and arts-informed projects were most likely to produce positive outcomes. Another systematic review on private-public partnerships for health found that specific partnership models, governance structures and sustainable plans that were founded on clear communication and trust were most fruitful. Lastly, a review of evaluation measurement tools and strategies was undertaken and used to inform a model of evaluation that suggested specific qualitative and quantitative approaches to assess the impact of youth engagement activities. Knowledge Translation: Knowledge translation was undertaken under the broad goal of improving network effectiveness and scope and impact of work conducted as part of Food4Health. Social media tools like Twitter, Facebook and the TakingITGLobal web community were the most popular and widely engaged tool. Partnership development through face-to-face and virtual introductions made by the Food4Health team was another key strategy. A series of public events supported by promotional materials further provided opportunities to reach each constituent community of interest in support of the Food4Health project goals. Although the short timeframe limited some of the reach of projects, the challenge associated with the schedule provided novel opportunities for innovation in health promotion. Through creating opportunities that recognize the dynamic nature of youth engagement the potential to create a healthy, prosperous, and creative population can be realized.

Appendix 1: Youth Leaders: Food4Health Summary Results

1. Community Action Projects Action Projects 1.1 Stomach This! Peer education workshop on food security, developed in collaboration with Meal Exchange, pilot tested with twenty youth aged 15-24

1.2 Food4You! An “un-conference” bringing together youth and adult stakeholders, within an “open spaces” format where the agenda was created by participants 1.3 4H Youth Leadership Evaluation Partnership with Ontario 4H to create a evaluation resources for their youth leadership programming

Key Outcomes

Next Steps

Participants felt energized by meeting other young people, learning more about food security and experimenting with peer facilitation techniques.

All participants made a commitment to delivering the workshop to peers in their own communities

Pre/post surveys indicated that the workshop increased knowledge about food security issues, and intent to take action

Meal Exchange also p ans to offer the training as professional development of their youth coordinators, as well to external community organizations.

Created a participatory environment in which youth were actively engaged

Inspired local community-based actions, including a forum at the Havergal institute, a community garden at Lawrence Heights Middle School and a youth media publication by Regent Park Focus

Generated broad-based discussion and innovative solutions, and fostered connection and collaboration Pre/post surveys revealed selfreported positive outcomes in all leadership skill areas, including a statistically significant increase in the average score of responses to the statement “I consider myself to be an effective leader”

Evaluation resources will be implemented and adapted to continue to document programmatic outcomes Also identified potential for future collaborations with Food4Health and other community partners

Action Projects 1.4 Growing Reflections, Understanding Bites New and interactive classroom resource looking at youth perspectives on food choices and food systems 1.5 Ontario Agri-Food Education (OAFE) in the Classroom School-based workshop for teachers highlighting the agri-food education resources offered by OAFE

Key Outcomes Adapted for use within both traditional and virtual educational settings Edited to include stronger curriculum links and both local and global perspectives

Next Steps To be pilot tested within various educational settings

Creation of an online educational game addressing food issues

First pilot test completed with New Outlook - a mental health promotion youth group. All participants revealed that they had gained new knowledge and enjoyed the material

Pilot tested at two GTA schools: Lawrence Heights and University of Toronto Schools

Integrate a follow-up to determine whether or not teachers have used the resources.

Response from teachers was extremely positive, many indicated the intent to use the resources asap

Implement further workshops and assist OAFE educational partners To this end an evaluation resource was also constructed for the OAFE partner Green Thumbs, Growing Kids

2. Research and Knowledge Translation Research Project 2.1 Current Practices in Youth Engagement Evaluation Environmental scan of current practices for evaluating youth engagement in health promotion.

Key Findings There are significant variations in the evaluation capacity among organizations, from formalized academic models to more informal processes Most evaluations do not focus on achieving “youth engagement”, but rather focus on process indicators such as number of participants and changes in knowledge or skills

Recommendations Evaluation processes need to be meaningful, useful, and doable for organizations with limited capacity. Coordinated evaluation resources are needed addressing youth engagement outcomes and capacities

2.2 Systematic Literature Review: Youth Engagement and Health

General search:1969 citations Article review: 26 for final analysis.

Review and summary of peerreviewed academic literature that has demonstrated a relationship between youth engagement, health promotion, and the health and well-being of young people and their communities.

3 forms of engagement commonly used synchronously: Peer leadership, Take a socially inclusive approach to Participatory action research and Peer youth engagement. education Youth engagement, at its best, occurs Most focus on behaviours, attitudes, from start to finish. skills, and knowledge on topics like substance use and sexual activity Provide resources and support for youth-initiated projects and youthSome focus on broader health adult partnerships promotion and community development. Youth effective as Investigate “grey” literature agents of change. community-based knowledge production

Increase the focus on youth engagement for long-term positive health and well-being

Research Project

Key Findings

2.3 Systematic Review on Public Private Partnerships for Public Health

Formation stage: need to recognize motivations and all partners interests, define roles and outline shared risks

Operation: Build strong scientific capacity of local researchers and partnering with stakeholders

Systematic search and analysis of the best available evidence on partnerships between public sector and private sector for health goals

Coordination/Management: Need platform for regular communication, clear management guidelines and strategy for knowledge translation

Sustainability: Promote local ownership and encourage other organizations to participate

2.4 Food4Health Evaluation Model

Key definitions and quantitative scales under investigation with a focus on two main areas: eHealth and youth engagement

Key definitions and measurement scales to be further refined

Working research group created to develop a common approach to designing and evaluating youth engagement programs

Also investigated the use of a qualitative tool called the â&#x20AC;&#x153;spidergramâ&#x20AC;? for powerful and approachable program visualization and evaluation

Recommendations

Further testing of measurement properties and evaluation tools, including for reliability, sensibility and validity

Food4Health A Youth Leadership Project for Health Promotion: Internal Evaluation Report Lia de Pauw, Internal Evaluation Leader Cameron D. Norman, Principal Investigator

Youth Voices Research Group Dalla Lana School of Public Health University of Toronto

Appendix to the final report for the project term February 23 to April 30th submitted to the Ontario Ministry of Health Promotion June 14th, 2009

Food4Health Evaluation Report 1.0 Introduction and Rationale: The Ontario Ministry of Health Promotion funded the Youth Voices Research Group to implement Youth Leaders: Food4Health (Food4Health) from February 21, 2009 to April 30, 2009. This 10-week research project brought together stakeholders from the public health, agri-food, technology, and poverty and hunger sectors to facilitate youth engagement action and evaluation in support of chronic disease prevention and community health in Ontario. Food4Health incorporated several innovative elements, namely: • Engaging urban youth in food systems issues – particularly agri-food issues; • Using youth engagement methodologies to transform rural youth programs; • Fostering collaboration between the agri-food sector and the public health, youth engagement and technology, and poverty and hunger sectors; • Research methodology grounded in the theory of complex adaptive systems, and using arts-informed methodologies and rapid-response action research and evaluation cycles; and • Information and communications technologies for project coordination and ‘real-time’ knowledge translation. This report documents the perspectives and observations of the investigators, the research team, and community partners on the implementation of the Food4Health model and potential for scale up. 2.0 Methodology: A total of 17 semi-structured interviews were conducted. Interview schedules were designed for a) implementing members of the research team (i.e., the Principal Investigator [PI], Youth Voices Research Manager, research coordinator and research assistants [RA]), b) collaborating investigators, and c) community partners.1 The interviews with the research team focused on understanding the research process and its potential for health promotion. The interviews with the collaborating investigators focused on understanding the Food4Health project within the larger systems of the agri-food and public health sectors. The interviews with the community partners examined the value of the project and the potential for future cross-sectoral collaboration around food issues. A total of 17 interviews were conducted, including the PI both collaborating investigators, the Youth Voices Research Manager, the Research Coordinator, 12 of 14 RAs, and 4 community partners (1 form the poverty and hunger sector, 2 from the agri-food sector, and 1 for the youth engagement and technology sector).2 The interviewer took notes on the themes and perspectives discussed by each interviewee. These notes were later analyzed to identify themes and perspectives. 3.0 Findings: 3.1 Proof of Concept

Interview questions are available in Annexes 1 – 3.

This includes: MealExchange, 4H, Ontario Agri-food Education (OAFE), and TakingITGlobal (TIG).

3.1.1 Innovative Features Food4Health served as a ‘proof of concept’3 for the unique and innovative features in the project’s design and approach (see section 1.0). 3.1.1a Upstream Thinking: Health and Wellness through Youth Engagement in the Food System The Food4Health project concept was created by thought-leaders in the agri-food and public health sectors, namely Drs. Alex Jadad, Rob McLaughlin, and Cameron Norman. They posited that urbanization has led to a growing disjuncture between people and agriculture. These thought-leaders wanted to see if young people could be engaged in dialogue and action around food system issues; they hoped that this would result in greater awareness and more informed choices around food and eating. The Food4Health project illustrated that young people are interested in food system issues, including agriculture and food production. Interviews with the research team – many of whom are youth – illustrated the potential for open dialogue and debate around broader food system issues (e.g., the environment and poverty/hunger) to catalyze behaviour change in food habits. 3.1.1b Intersectoral Collaboration The Food4Health project demonstrated the role that informal collaboration can play in achieving intersectoral action, as described in the Ottawa Charter for Health Promotion. The community partners reported having little, if any, previous experience collaborating outside of their sector, even when their objectives spanned sectoral boundaries (e.g., health is one of the four pillars in the 4H program). Youth engagement was used a relatively non-political vehicle for spanning boundaries and encouraging collaboration among the agri-food, public health, poverty and hunger, and technology sectors. Activities such as the unconference provided opportunities for stakeholders from these diverse sectors to come together to talk about, explore, debate, and challenge ideas about the food system. There was a palpable enthusiasm among interviewees around the connections made during Food4Health and a desire for further collaboration between the sectors. A range of options were shared from cross-promotional initiatives - such as posting OAFE’s educational resources on TIG’s open access library - to longer-term, jointly developed projects that scale up the Food4Health concept. Youth Voices was seen as the bridge that brought partners together and promoted collaboration. Health promoters on the research team saw Food4Health as an example of the importance of actively seeking out partners and opportunities for collaboration, indicating that networking and relationship maintenance - particularly with nontraditional partners such as the private sector – are key competences for the profession. 3.1.1c Interrelated Subprojects: The Whole is More than the Sum of its Parts

3 Proof of concept refers to “…is a short and/or incomplete realization (or synopsis) of a certain method or idea(s) to demonstrate its feasibility, or a demonstration in principle, whose purpose is to verify that some concept or theory is probably capable of exploitation in a useful manner… The proof of concept is usually considered a milestone on the way to a fully functioning prototype.” From: http:// en.wikipedia.org/wiki/Proof_of_concept

The Food4Health project included several interrelated subprojects. While members of the research team did not understand the connections between the subprojects initially, they began to see that the value addition of this approach as the project progressed. Team members were able to draw on the feedback and lessons learn in other subprojects to enhance their own work, while the subprojects provided laboratories for cross-learning and refining innovations (e.g., the evaluation tool designed in one subproject was piloted in another). 3.1.1d Campus-Community Partnerships There is a growing trend towards campus-community partnerships in health promotion research. Several lessons were learned through Food4Health: Community engagement in health promotion research contributes to closing the know-do gap: Empowerment and participation are central strategies within the health promotion field. Community engagement in research applies health promotion’s strategies of empowerment and participation towards closing the gap between evidence and practice (known as the know-do gap). Food4Health demonstrated how research can be used to both integrate innovative community practices within the evidence base and to expose community partners to knowledge that can be adapted and applied in their context. Equalizing Campus-Community Partnerships by Taking The Community’s Lead: Typically, community-engaged research – even community-based research - is structured in ways that look more like a university project than a community project. The Food4Health project demonstrated new ways and more equitable for the academy to work with the community. First, the PI took the community partners’ lead by asking them to define the ways that Youth Voices could contribute to and optimize their work. Second, research methodologies were selected that reflect approaches used by community partners. Third, the PI is committed to ensuring that Food4Health’s research products are developed in ways that are accessible to community partners. Community partners recognized and appreciated these efforts to nurture equitable partnerships. Validating the Community’s Expertise: The systematic review pointed to a lack of scholarship on the process and outcomes of youth engagement. The power of youth engagement, however, is tacitly recognized among community organizations and the practice is rapidly expanding in Ontario and around the world. Academics can harness this knowledge by working with the community to conceptualize and disseminate innovative and effective youth engagement processes already in use. Interest in community partner’s approach also has the effect of validating their work, particularly given the weight of universities within society. We all win: The benefits of campus-community partnerships are not limited to the community. Community partners emphasized that their relationship with Youth Voices offered benefits to Youth Voices as well. For example, the scale, scope, and continuity of 4H provides a large data set that Youth Voices could leverage to develop a better understanding of the social and health outcomes of youth engagement processes. 3.1.1e Social Media in Health Promotion Food4Health demonstrated that social media - such as Facebook, Twitter, and TIG – have the potential to open up science so that evidence can be mobilized immediately and the research process becomes more responsive to knowledge users.

Several members of the research team were not regular social media users at the beginning of the project and were skeptical of its application in a research project. By the end of the project, all members of the research team indicated that they saw social media as beneficial for social media for knowledge translation, project coordinator, policy dialogue, and social mobilization. There was a high degree of confidence among team members that they would use social media in future health promotion research and practice. Team members linked the effectiveness of social media in knowledge development and mobilization to the active engagement of knowledge producers and knowledge users. They identified the following strategies to enhance the effectiveness of social media in research projects: It is more likely that an audience will be engaged and when the information sharing process is dynamic. This requires regular and ongoing knowledge translation be structured into the research project. An audience can be drawn to a project’s social media through cross-advertising on relevant websites and inclusion of links for the project’s social media in the email signatures of all team members. Concentrate the audience and knowledge sharing in one or two social media, rather than using multiple tools. Use other social media to drive people to these media. Different social media tools serve different purposes. Social media are most engaging when one understands how and why to use specific tools. 3.1.1f Transforming Knowledge Development and Mobilization Knowledge development has traditionally been conceived as a linear process: A research question is identified, a research project is designed, funding is secured, the project is implemented, the results are written up and published in a peer-reviewed journal with little guarantee that that practitioners will access and apply knowledge. Food4Health demonstrated that researchers could compress the gap between research and practice (known as the know-do gap) through open, two-way communication with knowledge users during the research process. The feedback loop enable the research team to identify and respond to challenges in the research design as well as ensuring that community partners were immediately able to put knowledge into action. This collaborative, iterative approach has the potential to not only move ‘scientific’ knowledge into to practice, but also to harness local knowledge so that it can be translated to a wider audience and brought to scale. 3.1.2 Time Pressure: A Facilitator and Barrier to Success There was unanimous agreement among interviewees that an extraordinary amount of work was accomplished during this short project: One of the collaborating investigator estimated that 8-months of work was compressed into 8-weeks. Most interviewees believed the time pressure was a key factor in the project’s success. The short-term nature of the project was perceived to have motivated the research team and community partners by creating a sense of immediacy, intensifying buy-in, and accelerating the project’s momentum. The following factors were identified as facilitators to Food4Health’s success within the time constraints: Social media accelerated relationship building and project planning;

The use and adaptation of existing tools and technologies (e.g., unconference methodology, Youth Voices methodology, social media platforms, etc.) made rapid innovation possible; Existing connections and positive regard between Youth Voices and community organizations â&#x20AC;&#x201C; including Food4Health community partners - facilitated RAsâ&#x20AC;&#x2122; efforts to engage stakeholders; Interest and readiness among community organizations to organization around youth engagement in food system issues; A clear vision of the outcome and process for Food4Health that was shared between Youth Voices and the community partners; and Sufficient financial resources and human talent to achieve the desired results. A few members of the research team saw the short time frame as a constraint to success. The key constraints highlighted include: Personal effectiveness was limited by not having enough time to undertake background learning to inform their work (e.g., understanding a partner sufficiently to make provide context-relevant evaluative comments, how to use social media effectively, or how to do a systematic review); Personal engagement in the various aspects of Food4Health was limited by competing priorities (e.g., graduate course work, family, graduate admissions process, etc.); Teams with different life rhythms and priorities had difficulties coordinating schedules to meet the demands of the project; and The time frame constrained the project on short-term outcomes to the detriment of medium- and long-term outcomes. 3.1.3 Benefits of the Project to Community Partners Both community partners and Food4Health team members provided an assessment of the perceived benefits associated with participation in the project. According to community partners, Food4Health provided the following benefits Creating intersectoral bridges: Youth Voices created bridges among their community partners from the agri-food, poverty and hunger, and youth engagement/technology sectors. The opportunity to connect with other organizations provided the opportunity to optimize their individual and collective work. For example, Ontario Agri-Food Education (OAFE) was able to extend the reach and use of their resources into urban schools, while TakingITGlobalâ&#x20AC;&#x2122;s (TIG) on-line food systems classroom was strengthened with globally-focused and technical content. Resources to Support Organizational Capacity and Goals: Community partners were able to access financial and technical resources that strengthened their organizational capacity and ability to realize their goals. For example: o The MealExchange was able to develop a curriculum and build facilitation skills to engage youth in poverty and hunger issues; This curriculum now been integrated into their ongoing programming on post-secondary campuses. o Evaluation tools were designed, piloted, and refined for several of the partners. o Community organizations were supported through the purchase services where necessary and feasible (e.g., TIG was contracted to design the Food4Health web page). 3.1.4 Benefits of the Project to Research Team The research team identified many personal and professional benefits arising from their participation in Food4Health. Several people noted that there was not a clear distinction

between personal and professional benefits, but rather these categories overlapped. The following were identified as the key benefits: Food Issues: Personal Awareness and Habits: While members of the research team came to the Food4Health with different levels of awareness of food system issues and food habits, the project appears to have supported movement towards healthier habits. Some team members moved from not thinking about food issues to making conscious choices about where to shop, what to buy, and the health value of their food choices. Some team members had faced obstacles to healthy eating even though they identifying as being conscious about food issues; these people noted that their personal food habits improved through the opportunity to engage in ongoing reflection and learn food strategies from other team members. Other team members were very aware of food issues and/or worked consciously to cultivate healthy food habits, but appreciated the opportunity to broaden their perspectives on food security. Networking: The research team â&#x20AC;&#x201C; and particularly the graduate student RAs appreciated the opportunity to build connections with other members of the Food4Health team and community agencies. One RA noted that the opportunity to be a part of team enhanced her graduate student experience, as most students go through the Health Promotion program at the same time but not together. Mentorship and Experiential Learning: Food4Health enriched the academic training of the graduate student RAs by providing an opportunity to apply the theories and skills learned in courses to a real world setting. Graduate student RAs also appreciated the opportunity to learn from and be mentored by the PI. Professional skill development: The research team was primarily made up of graduate students in public health (primarily health promotion) or other people in a career-building phase. Food4Health provided team members with opportunities to strengthen their professional and research competencies. This includes: exposure to new and dynamic ways of doing research; skills in areas such as database searches, systematic reviews, and survey design and analysis; skills in project coordination; increased awareness and skills in social media; and community engagement skills. 3.1.5 Potential Barriers to Future Collaboration As noted in Section 3.1.1b, there is a strong interest among community partners and investigators to build on the Food4Health concept. The following factors were identified as potential barriers to further collaboration: Community Partners Engagement is Constrained by Resources: Most community agencies operate on a zero-balance budget, which means that funding is needed to invest human and technical capacity in collaborative projects. Momentum Might Be Lost if there are Delays in Embarking on the Next Phase: A great deal of momentum was built and connections with many new players were made during the 8-weeks of project implementation. These gains may be lost if there is a significant gap between the close of Food4Health and the implementation of the next phase. Threats to the Diffusion of the Youth Engagement and Leadership Innovation: Several threats to the ongoing diffusion of the youth engagement and leadership innovation were highlighted. First, competing priorities may rise in importance on

decision-makersâ&#x20AC;&#x2122; agendas and displace upstream thinking and youth engagement. Second, fear and a desire to avoid risks are common during times of economic crisis, which may lead to a retrenchment towards familiar practices and a thickening of the silo walls between sectors. Third, adults may overlook what young people have to offer or be fearful of sharing power with young people. The Capacity in the Agri-Food Sector for Youth Engagement with Urban Youth: One community partners expressed a need to build capacity among adults in the agrifood sector so that they are able to successfully engage in dialogue across differences with urban youth. This is particularly important given diverging values and perspectives around issues such a genetically modified foods and mono-crops. 3.2 Creating the Conditions for Self-Organizing Research Teams The general consensus among the research team is that the vision of self-organizing teams working towards a common goal was successfully realized. The following factors were identified as the key factors in successful self-organization: Hire for fit: The PI knew that the Food4Health research design was unconventional, and he would need a team of nontraditional thinkers with a diverse range of skills. The staff recruitment process was designed to encourage the self-identification of people who could excel in a team-based, self-directed, minimally structured position. The position description, for example, was for the project generally rather than for specific positions with specific skill sets. This approach proved successful, with many team members noting that the right people had been brought together to form a cohesive group with a wealth of collaborative and technical skills Clear roles: The overall scope of work was divided into priority areas (i.e., subprojects). Staff were then assigned to subprojects based on their skills, interests, and other constraints (e.g., other jobs, geographic location, etc.). For the most part, RAs felt that roles and responsibilities were well articulated, even when the subprojects were not clear or changed over time. Some people would have liked more clarity around the roles and responsibilities of the members on subproject teams. Flexibility: The staffing structure was sufficiently flexible to enable human resources to be shifted as needs emerged. RAs were able to draw on each otherâ&#x20AC;&#x2122;s time, skills, and expertise to meet the needs of their subprojects. Staff resources were easily reallocated to new and changing priorities as they emerged. Balancing structure and freedom: The success of self-organization hinges on the right balance between structure (i.e., expected duties and outcomes) and freedom. Some RAs felt that the balance was just right, enabling them to apply their creativity and talent towards implementing subproject. Others felt that their effectiveness and ability to act independently was constrained by an incomplete understanding of their subproject and/or its connection to the overall project. RAs perspectives may have been influenced by propinquity (i.e., those who worked most closely with the project leaders were more comfortable with the balance) and previous related work experience (i.e., those who had more related work experience were more comfortable). Responsiveness: The PI recognized that questions and obstacles would arise throughout the project. Recognizing his time limitations, he hired a research coordinator to act as the interface with the RAs. Responsibility and authority for independent decision-making were delegated to ensure the functionality of this

structure. RAs recognized that the PI had limited availability and appreciated having an easily accessible ‘go-to’ person. High degree of trust between leadership and staff: The PI knew that successful selforganization required responsibility and authority be delegated to the research coordinator and RAs, which, in turn, required a high degree of confidence and trust in the members of the research team individually and collectively. The PI limited staff recruitment to people in his own and the Youth Voices Research Manager’s social networks, in the belief that they would be more likely to quickly identify people with the requisite skills and an incentive to perform in the short time period. The project leaders strove to demonstrate confidence and trust in the RAs through their words and actions, for example, by delegating responsibility, encouraging independent thinking and decision-making. The RA interviews indicated that the efforts to establish a high degree of trust were successful. RAs felt that: the project leaders validated and appreciated their work, the Youth Voices mandate was reflected in the management process (i.e., their voices were valued), they had been encouraged to be creative and use their skills, and they were treated as peers rather than assistants. A high degree of transparency and open communication ensured that the RAs also able to trust the project leaders. It was noted that while there were many unknowns in the project, what was known was openly shared with the RAs. Deep respect for the leadership: Many of the RAs expressed a deep respect for and commitment to the PI, which motivated them to make Food4Health successful. Qualities that engendered this respect include: a vision that resonated among the RAs, enthusiasm for the project, recognized expertise in health promotion and social media, well-developed people skills, a kind and supportive approach, and a deep commitment to the student experience. Personal engagement: The research coordinator and RAs developed and were motivated by a growing sense of personal engagement and ownership in the project. For example, people expressed an excitement to see the project progress from beginning to end, to see their creativity shine through, to feel that they were part of something larger than themselves, and to have the opportunity to gain personally and professionally. Learning Approach: The Food4Health created experiential learning opportunities for team members. The RAs felt that they were not expected to join the project as experts but rather were encouraged to learn new skills and engage with new content. Sufficient resources: The available financial resources enabled both the individual subprojects as well as the overall project to flourish. Access to expertise, technology, workspace, and community partners were made available as requested by RAs. Social Media for Team Building and Project Coordination: Several members of the research team perceive the social media tools as building a sense of connection to the team larger project - even if they were working at a distance – and supporting project coordination by encouraging cross-learning and supporting problem-solving.

Annex 1: Research Team Interview Questions 1. What did you gain personally and professionally through your participation in the Food4Health project? (prompts: food habits, social media, food and food security, research) 2. What worked well in your project - or the Food4Health project more generally - and why? What facilitated your ability to be effective? 3. What limited your ability to be effective in your project(s) - or the Food4Health project more generally â&#x20AC;&#x201C; and why? 4. What do you see as the role of these tools (i.e., action research, social media, and community engagement) in your work? 5. What opportunities did you see the Food4Health project creating for community partners?

Annex 2: Collaborator Interview Questions 1. How has this project fostered a greater connection between the agri-food/agricultural sector and the health & technology sectors? 2. What do see as the most important lessons learned from this project for your sector / field of work/study? 3. What meaningful collaborative opportunities do you see emerging from this project that would be of interest to groups and individuals within your sector? 4. How is youth engagement typically viewed within your sector? 5. What barriers do you see in moving ideas like the ones explored in Food4Health - such using technologies like Twitter and Facebook to communicate with the public, campuscommunity partnerships, youth leadership - into the mainstream? 6. What do see as the greatest opportunities to move youth engagement and youth-adult partnerships into the mainstream within your sector?

Annex 3: Community Partner Interview Questions 1. How has the collaboration with the Youth Voices Research Group at the University of Toronto influenced (or impacted) your organization?, and/or what do foresee as the benefits or products coming from this partnership? 2. What (if any) past collaboration has your organization had with other organizations that come from other sectors (such as public health and agri-food)? 3. What opportunities do you see for future collaboration between Youth Voices, the U of T, and the other sectors at large? 4. What needs to happen for these opportunities come to fruition? 5. Provide any further thoughts or reflections on your experience with the Youth Leaders: Food4Health project and the role of youth and young adults in transforming the agri-food system.

Food4Health A Youth Leadership Project for Health Promotion: Internal Evaluation Report Lia de Pauw, Internal Evaluation Leader Cameron D. Norman, Principal Investigator

Youth Voices Research Group Dalla Lana School of Public Health University of Toronto

Appendix to the final report for the project term February 23 to April 30th submitted to the Ontario Ministry of Health Promotion June 14th, 2009

Interview questions are available in Annexes 1 – 3.

This includes: MealExchange, 4H, Ontario Agri-food Education (OAFE), and TakingITGlobal (TIG).