“It has made my life healthier.”
Outcome evaluation of the Capital Chicks CANberra initiative.

June 2021

ACKNOWLEDGEMENTS
Thank you to those women who participated in the survey and who gave their time to contribute their insights, experiences, and opinions to this research. We hope that through documenting your views and experiences, local ACT responses can be improved so that women’s health and wellbeing needs in the ACT are better understood and will be better met in the future.

Publication/Copyright Information
© 2021 Women’s Centre for Health Matters Inc. Published by Women’s Centre for Health Matters Inc. This publication is protected by copyright. Apart from any use permitted under the Copyright Act 1968, no part may be reproduced without acknowledgement.
Supported by ACT Health Directorate. 

About Women’s Centre for Health Matters Inc.
The Women’s Centre for Health Matters Inc. (Women’s Health Matters) is a community-based organisation which works in the ACT and surrounding region to improve women’s health and wellbeing. Women’s Health Matters believes that the environment and life circumstances which each woman experiences affects her health outcomes. Women’s Health Matters focuses on areas of possible disadvantage and uses research, community development and health promotion to provide information and skills that empower women to enhance their own health and wellbeing. Women’s Health Matters undertakes research and advocacy to influence systems change with the aim to improve women’s health and wellbeing outcomes. Women’s Health Matters is funded by ACT Health. 

The findings and discussion presented in this report are those of Women’s Health Matters, and not necessarily those of the ACT Health Directorate.

About the Author
Amber Hutchison is a Health Promotion Officer at Women’s Health Matters. Her areas of specialty are chronic conditions, nutrition and physical activity, with a special interest in LGBTIQ women and older women. Amber’s background is in health, specifically nutrition and dietetics, and has worked in a number of health care settings such as aged care, medical centre’s and hospitals. She uses her skills and knowledge from these different settings to help highlight health wellbeing issues for women, and to influence and advocate for changes in the health system. She is passionate about creating societal change, promoting equitable outcomes, and fighting for social justice.

Contents
Introduction
Executive Summary
Methodology
Literature Review
How women value health behaviours
Health information
Barriers to health behaviours
Differences in age groups
Findings
Demographics: the women who completed the survey
Joining Capital Chicks CANberra
When women joined
Why women joined
Finding Capital Chicks CANberra
Improvement in awareness
Lifestyle factors they were more aware of
Explanations as to why they weren’t aware
Awareness of specific lifestyle risk factors
Changes in habits and lifestyle behaviours
Lifestyle changes
Specific lifestyle changes
Managing their health and wellbeing
Connection to local women
Usefulness of Capital Chicks CANberra platform
Recommendation to friends
Feedback and suggestions
Positive feedback
Feedback on the technological aspects of the initiative
Content
Face to face
Other
Lessons learned
Joining Capital Chicks CANberra initiative
Awareness of lifestyle factors
Behaviour change and managing health
Social connection
The platform
Valuing the initiative
Recommendations
References

Introduction
Women’s Health Matters have been working to improve women’s health and wellbeing in the ACT for the last three decades. Women’s Health Matters is an independent, non-partisan think tank that works to improve the health and wellbeing of ACT women. They use women’s voices to highlight key health issues to influence gender blind health supports in the ACT. Because of this expertise, Diabetes NSW & ACT approached Women’s Health Matters to provide an independent evaluation of the Capital Chicks CANberra (CCC) initiative. 
The CCC initiative is a virtual ‘smart health community’ funded by ACT Health which commenced in June last year. The initiative's aim was to bring together Canberra women to turn the health of Canberra around, one step at a time. The CCC initiative was supported by the ACT government under the ACT Health Promotion Grants program.
The CCC initiative is underpinned by a digital solution which delivers significant impact at scale, very cost effectively. The platform provides online anytime, anywhere access to healthy lifestyle information, tools, and community. Members choose how and when they engage. This virtual ecosystem brings health care direct to people to tackle chronic conditions and encourage them to implement health behaviours to make positive changes in their lives and those around them. 
CCC was predominantly promoted through social media avenues such as Facebook and Instagram. Paid advertising was aimed at women 18 years and older in the greater Canberra region to encourage registrations.
The main driver of the initiative was to reduce gestational diabetes (GDM) in the ACT. The ACT has the highest rate in the country, and up to 70% of women who had GDM in pregnancy will develop type 2 diabetes. Originally, the initiative was to have an element of health coaching, but due to feedback from local stakeholders, the budget for this was re-directed. The health coaching component was subsequently de-prioritised.
The evaluation was conducted to obtain the views of women who have accessed the CCC platform to understand if they have had an improvement to their awareness, behaviours, ability to manage their health specific to life-style risk factors that influence developing GDM or type 2 diabetes since accessing the platform. 
The following evaluation collates and summarises the views of 109 women who accessed the CCC platform and participated in the survey. This evaluation will assess and make conclusions from the responses gathered and the platform in its current form. The report will not evaluate the platform on set criteria other than what was asked of the women in the survey.
The report contains the following sections; a methodology which describes how the research was carried out, a literature review of relevant Women’s Health Matters research, findings which include demographics and data analysis of the survey, and finally exploring the key findings in a section called learnings. Recommendations are contained at the end of the report.

Executive Summary
Women have the propensity to put others health before their own, often looking after their family’s health first. Prioritising women’s health has never been more pertinent than when they are pregnant, with benefits for both the mother and the child. The ACT has the highest rate nationally of gestational diabetes (GDM), which impacts one in every seven pregnant women tested.
After diagnosis of gestational diabetes, women are at increased risk of developing type 2 diabetes. Studies estimate this cumulative incidence to be between 2.6% to over 70% experiencing a diagnosis of type 2 diabetes when following up women between 6 weeks and 28 years postpartum. Additionally, a recent systemic review estimates the increased risk as being 10 times that of women who did not have GDM in pregnancy.
Diabetes NSW & ACT have identified a need for low cost, good quality health care and health information, supported by qualified health care professionals that fosters a supportive community for women. Capital Chicks CANberra (CCC) have been running since June 2020, during the COVID19 Pandemic health crisis. The online platform provides a community of women with workshops, workout videos, podcasts, self-assessments, recipes, expert advice, a community wall, and general health information specific to lifestyle risk factors for GDM and type 2 diabetes. 
Due to increased desire from women to join the platform who don’t have pregnancy on their radar, and may not need health advice specific to GDM (or type 2 diabetes), Diabetes NSW & ACT have increased the scope of the platform to meet this increased need. 
Women’s Health Matters, a trusted advocate for women’s health in the ACT, carried out an independent evaluation of the CCC platform to investigate outcomes for women using the platform. 
The evaluation found that women joined CCC to improve their health, to find health information specific to them and connect with local women and services. They reported improvements in their awareness of lifestyle factors that influence GDM and type 2 diabetes, had identified and made changes to their behaviour and were able to manage their health better.
Although they did not feel particularly connected to other local women they reported that they would recommend the CCC initiative to a friend.
Additionally, responses highlighted the need to investigate the useability of the website and mobile application to make it more user friendly.

Methodology
This evaluation was created to measure awareness and behaviour change in women who have accessed the Capital Chicks CANberra (CCC) platform since the launch in June 2020. Women’s Health Matters aimed to find out:
1)	Has women’s knowledge and awareness of life-style risk factors that influence developing gestational diabetes or type 2 diabetes improved since accessing the platform?
2)	Have the women accessing the platform been able to identify and implement positive habits or lifestyle changes and feel more able to manage their health?
3)	Do they feel more part of a community, or improved their social connections with local women?
4)	And finally, what parts of the platform have been useful, and do they have feedback or suggestions to improve the program?
The survey was promoted by emailing women who have previously registered for the CCC initiative. It was also promoted on Women’s Health Matters Facebook page and CCC Facebook and Instagram accounts. There was also a cash prize attached to encourage women to participate in the evaluation. 
Women’s Health Matters developed a 14-question survey to obtain both quantitative and qualitative data. Women self-selected to fill in the survey to capture those who were frequent users of the CCC platform and those that may no longer be using it.
The survey was open for a two-week period. A total of 109 valid survey responses were collected. Survey responses that were incomplete (had not filled in at least 5 questions), and those with answers indicating they had never registered for the CCC initiative were removed.
Anonymous survey responses were analysed quantitatively, and thematic analysis was undertaken on the qualitative responses. Engagement with Diabetes NSW & ACT provided opportunity for knowledge sharing which occurred at numerous stages through the 7-week project.
Limitations
The research was carried out as per Women’s Health Matters standard methodology framework. Women who participated self-selected, and so the sample may not be representative of all women’s opinions who accessed the CCC platform. The estimated sample size was 100-200 participants, and 109 women participated in the evaluation. We found that having only 109 participants impacted on the analysis that could be done on segment and age groups; due to smaller amounts of respondents in each group.

Literature Review
This short literature review highlights the current local research available about women’s needs specific to healthy behaviours.
How women value health behaviours
Women value participating in physical activity and eating healthily. Physical activity gives women an opportunity to make and continue social connections, to maintain an active lifestyle, and enjoyment. Healthy eating is considered a necessity for women which means that they value flexibility and eating a balanced diet.
Health information
Research highlights the relationship between good health outcomes and having access to health information. Awareness of lifestyle factors influencing gestational (GDM) and type 2 diabetes may help to motivate women to change their behaviour. Women want health information from trustworthy and credible sources. They often use online sources to find health information because it is easily accessible and timely. They want information that is specific to their circumstances and their backgrounds, therefore health information should show a diversity of ages, nationalities, and sizes. Messaging also needs to target them at their life stage as different life stages value different types of content. For example social media use is different amongst age groups, Facebook users are predominantly between the ages of 25-44 years old. 
Barriers to health behaviours
Barriers to physical activity for women include lack of time, affordability, safety, fear of judgement and poor or cold weather conditions. In local research, women discussed how they overcame barriers by engaging in physical activity that was social, problem solving what worked for them, and looking for low-cost options. Barriers to healthy eating included time, organisation and preparation, affordability, and lack of support. They overcame these barriers by trying to find what worked for them, making shopping or cooking a social activity, and accessing affordable food.
Affordability was an issue to participating in physical activity and healthy eating for women on low incomes. Whereas women with chronic conditions talked about how symptoms of the chronic disease was a barrier for participating in physical activity and healthy eating.
Differences in age groups
Women from different ages have distinct ways of talking about weight, diet and fitness. In local research conducted by Women’s Health Matters, women aged 16-44 were concerned about their weight, and their ability to eat healthy and participate in physical activity, whereas women aged 44-54 were more likely to talk of fitness specific to maintaining wellbeing, and diet and nutrition in terms of reducing symptoms related to chronic conditions. Women in age groups 55-64 years old mentioned concerns about their weight or the need to manage their weight. Women aged 65 years plus were concerned mostly about physical activity such as strength and balance training or maintaining exercise and fitness.

Findings
Demographics: the women who completed the survey
One hundred and nine women completed a valid response in a 2 week period during April and May 2021. Table 1 shows the age groups of the women who responded to the survey, and is reflective of the age groups that access the platform.
Age	Number	Per cent	
16-24 years old	1	0.9%	
25-34 years old	37	33.9%	
35-44 years old	53	48.6%	
45-54 years old	13	11.9%	
55 years and older	5	4.6%	
Table 1: Ages of women who responded to the survey.
Due to the low numbers of women answering in some age groups, some data won’t be able to be cross correlated.
Women were asked which life stage they selected on the Capital Chicks CANberra (CCC) platform. Most women selected ‘I am post pregnancy and not planning any more children’ and ‘pregnancy is not on my radar, keen to look after my health and prevent chronic disease’, as shown in Table 2.
Life stage	Number	Per cent	
I am post pregnancy and not planning any more children	46	42.2%	
Pregnancy is not on my radar, keen to look after my health and prevent chronic disease	41	37.6%	
I am trying to conceive	9	8.3%	
I already have children and am planning more	7	6.4%	
I have gestational Diabetes	4	3.7%	
I am pregnant and want to learn about gestational diabetes risk	2	1.8%	
Table 2: Life-stages of women who responded to the survey.
When comparing age groups to life stages there were differences in responses, specifically between the 25-34 year old group and the 35-44 year old group. The 25-34 year old group were more likely to report that ‘pregnancy is not on my radar, keen to look after my health and prevent chronic disease’ (n=20). Whereas the 35-44 year old age group were more likely to report ‘I am post pregnancy and not planning any more children’ (n=31), see Figure 1.
Figure 1: Age groups compared to life stages of respondents.
Figure 2 shows where respondents reported they lived in Canberra. The highest number of respondents lived in Belconnen (n= 27, 24.8%), followed by Gungahlin (n=18, 16.5%), and Tuggeranong (n=17, 15.6%).

Figure 2: Place of residence of respondents. Per cent total does not add up to 100% due to rounding.
The largest age groups generally made up the largest responses and reported Belconnen, Gungahlin, and Tuggeranong as places they live. The majority of women living in the Inner north are in the 35-44 age group (n=10).

Joining Capital Chicks CANberra
When women joined
Respondents were asked when they joined the CCC platform. Forty one per cent of women joined 3-6 months ago (n=45, 41.3%) with only 7.3% having joined in the last month (n=8).

Figure 3: When women joined the CCC platform.
Women who joined in the last 3 months (a combination of ‘In the last month’ and ‘1-3 months ago’) broken down by age groups.
-	25-34 years old (n=19, 47.5%)
-	35-44 years old (n=18, 45.0%)
-	45-54 year old (n=3, 7.5%)
Women who joined more than 3 months ago (a combination of ‘3-6 months ago’ and ‘More than 6 months ago’) broken down by age groups.
-	25-34 years old (n=18, 26.1%)
-	35-44 years old (n=35, 50.7%)
-	45-54 year old (n=10, 14.5%)

Differences between age groups
Fifty one per cent of women 25-34 years old reported (n=19, 51.4%) they only joined the CCC platform in the last 3 months, compared to 34.0% of 35-44 year old’s (n=18), and 23.1% of 45-54 year old’s (n=3).
Differences between life stages
Seventy two per cent of women that are in the life stage ‘I am post pregnancy and not planning anymore children’ (n=33, 71.7%) had joined the platform more than 3 months ago compared to 56.1% of women in ‘Pregnancy is not on my radar, keen to look after my health and prevent chronic disease’ (n=23), and 55.6% of women who are in the life stage ‘I am trying to conceive’ (n=5).
Why women joined
Women were asked what prompted them to join CCC. The largest response was that women joined because they wanted to be healthier and to pay attention to their health (n=23). 
“I wanted to use this platform to help motivate me to look after my health and wellbeing, it was a decision made in conjunction with other choices including becoming more active and eating better.”
“the overall vibe and commitment to health and wellbeing made it a no-brainer for me!”
“Tips on lifestyle changes to increase energy and be healthy.”
“Great initiative and wanted to prioritise health.”
“...it sounded like a good way to stay healthy.”
“To receive tips for health and wellbeing.”
Women also reported that they were looking for health information specific to their needs and mentioned specific lifestyle factors and in what form they want information (n=18).
“Heard about it and after having my other two thought it would be good to use to change habits post babies as I didn't do that between the first two and the weight increased.”
“I want to be healthier to be a mother. I saw Capital Chicks provides healthy lifestyle, exercises and dietary tips which is what I need.”
“Thought it was a good initiative and I was looking for affordable fitness options.”
“I joined because of the diet, health and wellbeing information but also for the workout programs.”
“Looking at recipes and information around health/exercise/diet.”
Women also discussed that they joined as they were looking to connect with local services, local women, and local specific information (n=17). 
“I was volunteering at an NGO in Canberra and they mentioned how cool the page was and that it was run by experts in the field. Desire for local advice on health and wellness.”
“Heard about it from a friend and was interested in a female focused community of like minded women “
“It looked like it would be helpful to me to learn more about resources for health and well-being available in Canberra.”
“Wanted to support a Canberra platform and find about local issues, businesses and local professionals and experts.”
“I liked the concept - thought it would be a good way to engage with local women and health activities and events.”
Some also commented on wanting to be healthier with a chronic illness or to reduce their risk. Women recounted their family history of chronic illness as a motivation for joining CCC, and others wanted to engage to improve their health after a diagnosis of gestational diabetes (GDM) (n=13).
“My mum had gestational diabetes when she was pregnant with me so I wanted to know more about the risk factors, as my partner and I are planning to start trying to conceive in the next few years.”
“I was diagnosed with gestational diabetes and part of my pack provided the details for Capital Chicks CANberra to assist with understanding the diagnosis and how to live with it, and keep it under control, while pregnant and after my baby.”
“I am very passionate of preventing chronic disease as my dad passed away young due to stroke!”
“Wanting to prevent getting type 2 diabetes after having gestational diabetes twice.” 
“I wanted more info on staying healthy to prevent diabetes.”
Some women also mentioned they joined because the initiative looked interesting and engaging.
Finding Capital Chicks CANberra
When asked how they found out about the CCC initiative, the highest response from women was through social media, more specifically through Facebook (n=22), as shown in Figure 4.
“I found out about Capital Chicks CANberra after … doing an internet search for local health and wellbeing options.”
“My counsellor introduced the project and suggested that it would be a good addition to my wellbeing regimen.”
“I found it on Instagram, and it sounded like a good way to stay healthy.” 

Figure 4: Where women found out about the CCC platform.

Improvement in awareness
Women were asked if they were more aware of the benefits of a healthy lifestyle for reducing the risk of GDM and type 2 diabetes after using the CCC platform. Most women who answered this question (n=106) were more aware of the benefits (n=62, 58.5%), than those that weren’t aware (n=31, 29.2%), or were unsure (n=13, 12.3%).
Slightly more than half of women aged 35-44 years old reported that they were not more aware, or not sure if they were more aware (50.9%, n=27) and this was more than other age groups, as seen in Figure 5. This finding was also similar to women who reported their life-stage as ‘I am post pregnancy and not planning any more children’ (52.2%, n=24).
There is a correlation between increased awareness and behaviour change, 75.8% of women who mentioned an increase in awareness of lifestyle factors that influence GDM and type 2 diabetes also reported they were able to change their behaviours after using the CCC platform. (compared to 46.8% of women who reported they were not more aware, or not sure, said they had not changed their behaviours).

Figure 5: Awareness of lifestyle factors that influence type 2 diabetes and gestational diabetes risk compared by age.
There were no differences of increased awareness of lifestyle factors in those who joined the platform less than 3 months ago or more than 3 months ago.
Lifestyle factors they were more aware of
The respondents that were more aware of the benefits were asked which lifestyle factors they were more aware of. The most reported lifestyle factor they were more aware of was a combination of healthy eating and physical activity (n=13).
“A combination of diet and exercise go a long way to reducing the risks of Type 2 Diabetes after child birth.”
“Diet and exercises role in helping reduce the risks of both these conditions.”
“Reinforced messages about diet and exercise.”
“Exercise, low GI [Glycaemic Index] eating.”
Other women mentioned they were more aware of food and diet (n=10).

“How much sugar I ate and also effects of stress on my eating.” 
“Improved diet with great recipes.”
“Making smart food swaps.”
And others about exercise and physical activity (n=10).
“Movement and exercise.”
“The benefits of exercise.” 
“Need to exercise.”
Women also talked about how they were more aware about health, and some mentioned the benefits of looking after their health in their relevant life stage (n=13).
“It highlighted the importance of being as healthy as possible at the point of conception.”
“I have more understanding and I might pay attention to my health when I am pregnant.” 
“Diabetes wasn't even on my radar before.”
“I am more aware of many health issues.”	
Some women made specific mentions of the platform that helped them become more aware of lifestyle factors (n=4).
“Love reading all the articles and tips.”
“I like the habits page it was good.”
“Yes, utilising the health and wellbeing checklist has given me more of an awareness of lifestyle factors.”
Some women also mentioned more awareness of the benefits of sleep and drinking water. 
Women that were in the life stage ‘Pregnancy is not on my radar, keen to look after my health and prevent chronic disease’ were far more likely to report that they were more aware about the benefits of sleep than the other life stages. Whereas women that selected ‘I am post pregnancy and not planning any more children’ were more aware of the benefits of exercise and physical activity.
Explanations as to why they weren’t aware
Respondents that reported they were not aware, or weren’t sure if they were aware were asked to explain why this was the case. Most reported that they were already aware of the lifestyle factors that impacted their risk of developing GDM or type 2 diabetes (n=22).
“I have a long family history of both type 1 and 2 diabetes so I have a pretty good understanding. When I got gestational diabetes I was also given/told a lot of additional info I hadn’t been aware of.”
“Capital chicks hasn't taught me anything I didn't know already.”
“I am already aware just finding it difficult to put into practice.”
“I was already aware of risk factors for diabetes.”
Even if some women already were aware of lifestyle factors, they felt that the platform was worthwhile as it provided motivation and helpful resources.
“I’m not sure that I have learnt more, but the continual reminders of things that I do know and increased motivation to put things into practice has been a real benefit of the program.”
“My parents both were diagnosed with diabetes so a lot of the information available was already on my radar, but the resources were helpful nonetheless.”
“I knew the benefits, but the platform reminds me and motivates me
Some women reported that they had not seen that information on the platform (n=7).
“I have not really accessed the information. Perhaps an app would be easier to access. I tend to ignore emails. So much spam these days.”
“Have not found the information easily accessible.”
“I don’t recall receiving information about it.”
And some women reported that it wasn’t on their radar (n=4).
“Haven't been paying too much attention as it is not something I need to factor into my life right now.”
“I can't say I paid much attention to anything to do with pregnancy because it's not on my radar.”
Others hadn’t interacted with the platform enough to increase awareness (n=4).
“…I found I didn't actually engage in the program enough to see any real benefits to knowledge unfortunately.”
“no, haven’t interacted enough with the platform.”
A few women reported that they wanted more nuanced information suited to them (n=2).
“I have since been diagnosed with GD and I haven’t really found this to be a place I go for info... I haven’t ended up using the exercises - they intimidate me. Need them to be really adapted to my stage of pregnancy so I don’t get discouraged." 
Awareness of specific lifestyle risk factors
Women were asked if they had become more aware of the effects of food, exercise and excess weight has on the risk of GDM and type 2 diabetes. Figure 6 shows that out of the women who answered this question (n=103) most reported that they were more aware of the effect of excess weight (n=72, 69.9%), than exercise (n=70, 67.3%), or food (n=65, 63.1%).

Figure 6: Awareness of specific lifestyle factors 
Figure 7 shows the differences between age groups. Age group 35-44 years old reported that they are not as aware of the impact of food, exercise and excess weight has on GDM and type 2 diabetes than the other age groups.
Figure 7: Awareness of specific lifestyle factors compared by age.
Women were able to explain whether they were more aware of food, exercise and excess weight on GDM and type 2 diabetes. Many women who felt more aware of the impact of food, exercise, and excess weight after using the platform mostly felt that CCC provided them with new and useful information.
“I didn't think I was that unhealthy until I had children and the impact of the excess weight plays on my health and theirs. The platform had helped me see many areas I can improve my habits and pass on to my children.”
“The information provided helps people make informed decisions. I personally have PCOS and while having difficulties conceiving, I need to take these factors into consideration while I am in a higher risk category for these health concerns.”
“Capital Chicks is a well rounded information source for women at risk of developing or trying to avoid lifestyle factors that play a role in the development of diabetes.”
“Maintaining a healthy weight through diet (monitoring sugar and refined carbs, portion sizes, high-fibre) as well as following the Australia's Physical Activity and Sedentary Behaviour Guidelines. “
“I wasn't aware of the link between exercise and diabetes.”
“There was a lot of information provided on these issues.”
“I think it helps me a lot and makes my life healthier.”
Most women who reported they were not more aware after contact with the CCC platform, reported they were already aware of lifestyle factors influencing GDM and type 2 diabetes.
“Already know a little about this as work in exercise sector, however do not read this information on capital chicks as not an area of interest.”
“I’m not more aware of this information, I’m more aware of my day to day choices because I’m reminded in the app.”
“It's not sharing anything I don't already know. The little chicks are annoying and condescending though so I'm probably not clicking through to more information.”
“Only because I already had this information.  It was good to hear again.”
“Already aware previously, but doesn’t hurt to be reminded.”

Changes in habits and lifestyle behaviours
Women were asked if they had identified changes that they can make to their lifestyle habits to reduce their risk of GDM or type 2 diabetes. Out of the women that answered the question, 71.1% reported that they did, and 28 women reported that they did not (28.9%). 
More women in the 35-44 year old category than other age groups reported they had not identified changes in their behaviour compared to other age groups (n=25), as seen in Figure 8.

Figure 8: Changes in lifestyle behaviour compared by age.
There were no differences of identified changes in lifestyle factors in those who joined the platform less than 3 months ago or more than 3 months ago.
Lifestyle changes
Women discussed what lifestyle changes they had identified to implement to reduce their risk of GDM or type 2 diabetes. 
Women identified positive changes to their food intake and physical activity behaviours (n=19).
“More aware of the importance of diet and exercise and make sure I spread the word amongst friends”
“Consuming less foods with processed sugar and going on regular walks to lose weight.”
“…definitely eating more healthily, and have been doing regular exercises.”
“…better food, food portions, exercise and mental well being.”
“Increase exercise, weight loss with balanced diet.”
Some women identified lifestyle changes to improve their eating habits that involved them making better food choices, reducing portion sizes and modifying sugar intake (n=13).
“Reduce carbs and eat more protein. And now starting to eat less meat and more veggie.”
“Yes not snacking so much on bad foods and swap them for better choices.”
“Yes, because of it, I reduced my intake of high-sugar foods.”
“Be more mindful of my sugar intake.”
Others talked about how they had identified improvements in their physical activity habits (n=9).
“I know I need to exercise more. I have joined … a gym in Mitchell.”
“Small amounts of exercise every day make a difference.”
“Incorporating more exercises/move more.”
“Yes, bought a cross trainer.”
Some women also mentioned specific parts of the CCC platform such as food tracking, health and wellbeing check tool, recipes, workout videos and prompts that have motivated them to make lifestyle changes (n=12).
“The food tracking is great. I love that it’s about food choices and not listing everything I eat so it’s quick and easy to use.”
“The questionnaire helps me to keep track of where I am going wrong and how I can do better.”
“The recipes and points around eating healthy are great.”
“Better eating through better recipes”
“Do the right thing reminders.”
Specific lifestyle changes
Respondents were asked if they had made any healthy lifestyle changes and asked to respond by choosing as many options from a list as relevant. Fifty four women in total reported that they had made a healthy change (49.5%).
Thirty six women reported they were preparing healthier meals (33.0%), 35 were doing more exercise (32.1%), and 28 were eating less sugary, salty and fatty foods (25.7%), see Figure 9 below.

Figure 9: Lifestyle changes made by respondents. 
For each of the changes made by respondents, they were given an opportunity to write what part of CCC initiative had motivated them to change their habits.
“There are exercise tips and recipes on the website that have sparked my interest in exercise and pushed me to become a better person.”
Food and nutrition
Women who responded to ‘preparing healthier meals’, ‘eating less sugary, salty and fatty food’, and ‘eating more fruit and vegetables’ predominantly referred to the recipes on the CCC platform as helping them to make healthy behaviour changes. Some women also mentioned articles, meal suggestions, and logging food.
“There is healthy recipes on the website, and because of it, I can make delicious and healthy food, so I will be healthier as well.”
“Logging food is an incentive to make healthy choices!”
“Yes - the newsletters provided good information.”
“Healthy Recipes in the Food section.”
“Good inspiration for different options.”
“Yes, great recipes available.”
Exercise
Women who mentioned they changed physical activity behaviour mostly reported that the workout videos helped them incorporate more exercise into their lives. There were also a few mentions of training plans, reminders, exercise ideas, articles, and logging exercise.
“There are exercise tips and recipes on the website that have sparked my interest in exercise and pushed me to become a better person.”
“Walking more but also using the videos on the app for core strength.”
“I'm using the online videos to compliment my other activities.”
“yup, training plans.”
“the daily tracking.”
Other lifestyle changes
Women who were able to implement changes such as ‘managing stress’, ‘sitting less’, ‘drinking more water’ and ‘getting more sleep’ mentioned campaigns, resources, newsletters, ask the experts, health and wellbeing tool, and videos.
“I have been getting more sleep and understand better by utilising the health and wellbeing tool how important sleep is to the body.”
“Reminder emails with links to relaxation techniques, Pilates and yoga exercises.”
“Articles - learning more about the right conditions for good sleep.”
“The daily check in has been useful for tracking stress.”
“Video - focusing on my breathing for a sense of calm.”

Managing their health and wellbeing
From the respondents who answered this question (n=83) most women reported that they did feel more able to manage their health and wellbeing after joining the CCC platform (n=51, 61.4%). Thirty two women reported that they did not feel more able to manage their health and wellbeing after joining the platform (n=32, 38.6%). 
Respondents commented on how the CCC initiative helped them to feel more able to manage their health. Some women pointed to specific parts of the platform that they found useful, such as the email reminders, health and wellbeing check point tool, support platform, and activity tracker (n=13).
“All of the hints and tips are really helpful to achieve a healthier lifestyle.”
“The regular email reminders and encouragement gave me the motivation to keep moving and carrying on with the walking program.”
“There is a lot of information that I can read and the questionnaire helps me to pinpoint exactly where I can improve and suggests what to read.”
“Yes, the tracker and regular check ins are handy, though I still don't use it as much as I should.” 
“Support and tips available. Can choose not to be so isolated.”
Women also reported that CCC provided good health information to help them feel more able to manage their health and wellbeing (n=13).
“Yes, it provides an informative resource to better understand my gestational diabetes and how to control it through diet and exercise.”
“I have somewhere to go for more information and where to check my wellbeing.”
“Information and support is always useful.”
“Yes - it provided clear information.”
“I have increased my knowledge.”
It also helped to keep women motivated on their health and wellbeing journey (n=5).
“Yes, because the platform makes it easier for me to get a healthy diet and exercise, and easier to stick to it. It also makes it easier for me to manage the body of the rank.”
“yes - keeps me on track and reminds me when falling off the track.”
“Yes great ideas and helps keep me motivated.”
Some women talked about using CCC as just one part of the numerous tools that they use to help them manage their health and wellbeing (n=5).
“I'm on a bit of a journey and capital chicks is one of many sources I am using for this information - it's great though.”
“Yes, knowing there’s support out there and we’re not alone.”
“This has provided me another resource to use to help me.”
Women who said they did not feel more able to manage their health and wellbeing after joining the platform reported a number of reasons why.
Some experienced barriers such as time and motivation, outside of the initiative (n=7). 
“time and focus poor, and didn’t engage a lot with the platform. However, I intend to do more and think it’s a great resource.”
“It doesn't matter what people say or the information given, motivation must come from within to change - and my motivation is low.”
“hasn't really changed my habits - the problem is time to focus on me.”
Other women reported that the platform wasn’t helpful or that they did not learn anything (n=7). 
“not really, I found this program might not been aimed at me enough, I am 25 year old women not with kids, looking for other females interested in health and fitness, not so much gestational diabetes.”
“I didn’t see any new suggestions that resonate with me.”
“Not really, I don't find it that helpful in its current format.”
One woman reported that she felt ashamed of having GDM as a women who is healthy and fit.
“The site does not acknowledge that sometimes people get gestational diabetes. I feel shamed that I have it despite being healthy and exercising.”
Other responses reported that they hadn’t used the platform as they had barriers to technology. 

Connection to local women
Most women, who answered this question (n=83), reported that they did not feel more connected to other local women with similar health goals after using the CCC platform (n=61, 73.5%). Twenty two women reported that they did feel more connected to other local women (26.5%).
Women were asked to explain why they did not feel more connected. Most women did not explain why they had not felt more connected, other than they had not interacted or formed connections (n=24).
“Not really, I love the app for the information it has but I certainly don’t interact with anyone locally by using it.” 
“No I've not formed any connections with others”
“I haven't interacted with other women.”
“I haven't made any connections.”
Other women said that they hadn’t engaged with that part of the platform (n=15).
“I didn't join any conversations or forums so didn't connect with anyone.”
“haven’t engaged with the platform much.  getting emails, quick read that’s it.”
“I haven't really used the social functions, but a buddy would be great.”
“I have not used the platform to meet/connect with others.”
“Haven’t actively utilised the platform to its full extent.”
Others felt there were barriers to using the platform for that purpose, such as that they were time poor, didn’t know about it or that the application was difficult to use (n=11).
“I find the app difficult to use which has hindered connection.”
“not really -- I just didn't have time to engage unfortunately.”
“Not really. I’m too busy.”
Some didn’t find the platform useful for the purpose of connecting to local women (n=7).
“Not really - I would like more opportunities to connect with local women at a similar stage of life.”
“not really, I found this program might not been aimed at me enough, I am 25 year old women not with kids, looking for other females interested in health and fitness, not so much gestational diabetes.”
“Definitely not, it's not really building a community.”
A few women reported that they did not want to engage with other women (n=4).
Women who did feel more connected to local women reported having a positive experience. They felt they were not alone, and found connection through sharing the same issues, and knowledge sharing (n=9).
“Yes! There are others out there who are like me and I am not on this journey alone.”
“aware that problems are experienced by many, not just me.”
“yes, it's nice to know that I'm a part of a community.”
“yes, knowing others are out there with similar goals.”
A few women said they felt more connected to local groups (n=2).
“More in touch with events and activities that are local, which is great.”

Usefulness of Capital Chicks CANberra platform
Women were asked which of the areas of the CCC platform were useful to them and their situation. Eighty five responded to this question, twenty five women did not say. For those who answered the question the most useful platform area was recipes (n=57), followed by reading the regular emails (n=56), the wellbeing check tool (n=44) and the health and wellbeing information-blog form (n=45), see Figure 10.
Figure 10: What platform areas of the CCC did respondents find most useful. 
Figure 11 shows the differences in the usefulness of the platform areas on the CCC platform between age groups. Sixty nine per cent of women aged 45-54 years old found the recipes on the platform useful, more than other parts of the platform (n=9, 69.2%). In comparison, women aged 25-34 years old found the health and wellbeing information – blog form to be as useful as the recipes.
A large portion of women out of the 59 women that hadn’t used the community wall reported that they did not feel connected to other local women with similar health goals (n=47, 79.6%). 
Of the 61 women that reported that they did not feel connected to local women with similar health goals, 47 women had not used the community wall (77.0%), 3 women did not find it useful, 7 found it useful and 4 did not say.

Figure 11: What platform areas of the CCC did respondents find most useful by age group.

Recommendation to friends
Most women, who answered this question (n=82), would recommend CCC to a friend (n=66, 80.5%), Sixteen would not (19.5%).
Many women reported they would recommend CCC to a friend because they felt the platform contains helpful information or was helpful to them (n=17).
“I think it's a positive local initiative and a way of building a health conscious community. this is really helpful for busy women who are juggling families and work.”
“It can be helpful if you have a particular health concern. Because life is busy & it's hard to put into practice what they offer.”
“Because it has helped me and I believe it can be helpful to others like me as well.”
“easy to use platform with lots of useful content.”
“Because of the wealth of helpful information.”
Most women commented that there was a lot of great information on the platform (n=15).
“Yes, it provided great information to manage my gestational diabetes and made me realise I wasn’t alone.”
“It's great! There are so many valuable resources and if I had more time I'd use it way more.”
“It’s full of great information and is motivating.”
“Definitely a good source of information.”
Some women reported that they would recommend the CCC initiative to a friend as it is free source of quality health information (n=8).
“Yes great resource and doesn't exclude people with a subscription cost.”
“yes - accessible free and holistic approach to health care.”
“Yes there's a lot of free Information all in one place.”
Others made comments that only if they had a friend that was looking for information, they would recommend the initiative (n=7).
“Yes if they are seeking the same or similar outcomes that I am”
“Yes, if they were concerned about gestational diabetes.”
“If they are looking for support and a community.”
Women also mentioned that local and practical advice were reasons why they would recommend the CCC to a friend.
Those that reported that they did not want to refer the platform to a friend reported that they did not find it useful, didn’t engage with it, or didn’t use it enough to warrant a recommendation to a friend (n=16).
“Probably not, because it doesn’t seem easy to use to me and is more geared towards those with health issues and little knowledge of exercise and healthy eating.”
“I don’t see anything from the page anymore for some reason, nor did I really to begin with, just random emails every so often.”
“It's ok, and I've read a few articles. I haven't found it particularly useful beyond information I could get elsewhere.”
“Not enough info and they have no intention of added new people into there click or making new people feel welcome at all.”
“Maybe, it's a bit cutesy and patronising.”

Feedback and suggestions
Fifty one women provided feedback or suggestions for CCC. Below is a list of their feedback.
Positive feedback
Much of the feedback was positive, about how they valued the support, motivation, and health information available on the platform.
“I started small with the 15min walking program mid Feb. I have extended my walking to 40mins a day. With a combination of smaller portions and a lot more water intake I have lost 9kg so far.  The regular emails (stretching exercises, meditation and meal suggestions) have been a great reminder and motivation tool for me.   I will try to look through the website in more depth to get more out of it - just haven’t had the time.”
“No but I like the cute jokes with the cartoon chicks”
“keep going and continue to support my well being.”
“The information is good. No changes.”
“Keep going and thank you!!”
“Keep up the great work!”
Feedback on the technological aspects of the initiative
Some respondents gave feedback about the usability of different technological aspects of the platform like the mobile phone application and website.
“Get better technology to support your valuable program.”
For the mobile phone application
“Is there an app? I looked in the play store but couldn’t find anything relevant. This would work better for android users.”
“App is a bit glitchy. More Instagram posts would be good. I love the program etc.”
“Just found app difficult to use.  Put me off using program.”
“App is a bit clunky.”
For the website
“Website can be tricky to use at times.”
“I found the website hard to navigate.”
“It’s a clunky website and not useful.”

For webinars
“Suggestion: just joined the food swap zoom on 27/4 at11am. Just a suggestion, can we have the next zoom at 12pm. I’m working full time, so It will be more convenient to use my lunch time to hear to a great tips. Thanks.”
“Can the podcasts be imported into a podcast app? This would make it easier to listen to on my commute.”
“Webinars outside business hours.”
For social media
“I actually haven't heard of Capital Chicks on social media.  From this I would suggest more social media exposure.”
“An Insta or Facebook page with community involvement to keep motivated would help.”
“Not very user friendly.  Instagram page doesn’t take you to any links.”
“Haven’t seen social media posts.”
For emails
“Stop sending emails every single day! I spend more time dealing with these emails, rather than actually being able to go and explore the platform any further. An email each week or each fortnight is a much better option. I don't remember being presented with any option about this when I first signed up.”
“I subscribe to a few emails (that only come once a month or less) and because they are not too frequent and have a wealth of helpful information I can’t wait to receive them. I think I thought this would be like that as there seemed to be some good info but I found the app confusing so probably haven’t used it to its full potential.”
Content
Some respondents talked about having difficulty finding information beneficial to their health and wellbeing.
“I think there are often too many steps to get to information. When emails are sent they usually contain a link which doesn’t necessarily open the target information straight away. If blogs and recipes were sent out in email format I would read them more.”
“I wasn't aware of all the different things that were available on the platform - maybe you already do this but little snippets of the different services on social media or when you log in would've been good to direct my attention. The messages I did get were often quite wordy.”
“Please link to all the different functions you have- I didn’t know they were all available and to be honest don’t have time to search for it all myself. Please bring it to me!”
Women also wrote specific suggestions and feedback to improve the different areas of the platform such as food recipes and workout videos.
“Low carb recipes able to be packed and taken to work or put in your bag as a snack would be good.”
“More recipe posts please.”
“The work out videos need to be graded by level of difficulty and intensity.”
“I haven’t ended up using the exercises - they intimidate me. Need them to be really adapted to my stage of pregnancy so I don’t get discouraged.”
Face to face
They also wanted an opportunity to interact with other women connected to the platform face to face.
“More about local programs or even event type of gatherings where we can meet.”
“more community engagement (in person yoga class by the lake for example).”
“Offer face to face events outside working hours.”
“More recipes and maybe host a catch up.”
“Social events?”
Other
Some women were put off the platform by the title, the cartoons and how welcome they felt.
“I was put off by the name so I dismissed it until I looked further into what the program was. I despise the ‘chicks’ part of the name as it seems irrelevant and sexist.”
“Yes the design and name is not great. It doesn't draw me in and feels like a cartoon approach for young kids rather than women. It makes me not really want to engage.”
“Make it more relevant to people without children.”
“You don’t make new people feel welcome   It’s just a click and if your new and not in the click you get no help or advice.”

Lessons learned
Joining Capital Chicks CANberra initiative
In A guide to getting it right, women highlighted the importance of health and wellbeing activities to not only improve their health but to make and continue social connection. Likewise, women who joined the Capital Chicks CANberra (CCC) platform were looking for ways to improve their health, were seeking health information specific to their situation, and connection with local women and local health services and supports. These three top themes were echoed throughout the evaluation highlighting the importance of these themes for women.
Research shows that women predominantly search for health information online, including through social media. Women predominantly found out about the CCC platform through social media, with many women mentioning Facebook as the main source. CCC was predominantly promoted through social media avenues such as Facebook and Instagram, with paid advertising aimed to encourage women to join. Women who participated in the evaluation were mostly aged 25-44 years, which reflects the women who are active on the CCC platform and of the ages who predominantly use Facebook. 
Awareness of lifestyle factors
Women’s Health Matters research highlights the relationship between good health outcomes and having access to health information. Awareness of lifestyle factors influencing gestational (GDM) and type 2 diabetes may help to motivate women’s behaviour change. In our evaluation we asked women if they were more aware of lifestyle factors as a result of using the CCC platform. Most women reported that they were more aware and this correlated with identifying positive behaviour changes that they could make to reduce their risk of GDM and type 2 diabetes.
More specifically women reported that they were aware of the influence of healthy eating, physical activity, and excess weight on GDM and type 2 diabetes as a result of using the CCC platform. Reasoning that the CCC platform had provided them with new and useful information.
The largest groups of women who were not more aware of the lifestyle factors influencing GDM and type 2 diabetes were those in age groups 35-44 years and who reported they were 'post pregnancy and not having anymore children’. The evaluation cannot draw specific conclusions and so further exploration is needed to identify if there is a nuanced reason this is the case.
Most women who reported they were not more aware of the lifestyle factors influencing GDM and type 2 diabetes stated that they already knew about them. While others mentioned that they had not seen that information on the platform, or it was not on their radar. This possibly was due to women joining the CCC platform with the intention to look after their general health rather than a particular chronic illness. This reflects the shifting membership of the CCC platform since opening to women who identified that pregnancy was not on their radar. Even so, the importance of information about the lifestyle risk factors influencing GDM and type 2 diabetes cannot be underestimated.
Behaviour change and managing health
Women’s Health Matters research shows that women understand the importance of incorporating positive lifestyle changes for their health and wellbeing. Most women who participated in the evaluation reported that they had identified behaviour changes they could make to reduce their risk of GDM and type 2 diabetes. And almost 50% of women reported they changed their behaviour, stating they were now preparing healthier meals and doing more exercise after using the CCC platform. They reported using different areas of the platform to help them implement behaviour change, with the most popular being recipes and workout videos.
Women stated they were able to better manage their health after joining CCC because they felt parts of the platform were helpful, it contained good information, and being a part of the initiative was motivating.
The 35-44 year old group contained the largest group of women who did not identify changes they could make to lifestyle factors influencing GDM and type 2 diabetes. There were no differences in responses to identify a plausible reason, and so clearly needs further investigation.
Social connection 
We know from past Women’s Health Matters research how important social connection is to women. Social interactions are often used by women to complement healthy behaviours, particularly when time poor. The CCC platform has aimed to create social connection for women with a community wall which is a space in the platform where women can discuss and share health tips, recipes, stories and encourage other women to meet their health goals. However, only 20% of women found the community wall useful. It should be noted that Diabetes NSW & ACT have indicated that new features are coming to the platform to support the community wall and connection between members.
Most women said that they did not feel connected to other local women with similar health goals after using the CCC platform but they did not explore the reasons why that was other than they had not interacted or connected with others. Other reasons women did not feel connected included not engaging with social connection activities or that they had not found the platform useful for connection, while some mentioned specified barriers. Three quarters of the women who said they did not feel socially connected had not used the community wall.
The platform
Local research shows that women focus on tailoring solutions that work for them and are specific to their situation. And likewise talk positively about health information that offers them a wide range of healthy options to choose what works. The CCC initiative provides registered users a platform broken up into different areas with health information and strategies giving users a wide range of healthy options. Women have the capacity to pick and choose which parts of the platform work for them. 
Throughout the evaluation, women told us about the different available options that they have used to improve their awareness, identify healthy lifestyle changes they could make and what changes they made. When rating the usefulness of these platform areas, more than half reported that the regular emails, recipes, wellbeing check tool, and the health and wellbeing information were useful.
The CCC use an external company to run their online platform and mobile application. The evaluation highlighted issues with the platform and the mobile application. In some cases, women were frustrated with these technical issues and this deterred them from using the initiative, or parts of the platform. Responses about the website and the mobile application were not specific but generally suggested that they were both difficult to use. Other women found difficulties with finding information and accessing specific areas on the platform.
Valuing the initiative
Throughout the whole survey, women have been able to tell us exactly how they felt about the CCC initiative. While there was constructive feedback about how the platform could be improved, there was also many positive comments. Women mentioned how helpful the CCC initiative had been in improving their health, providing them with health information and motivating them to make behavioural changes. 
Additionally, most respondents would recommend the CCC initiative to a friend, because they found the initiative helped them, there was lots of useful information on the platform, and it was a free initiative. The women who said they would not recommend it to a friend reported that they had not engaged with the platform or they did not find it useful. 
It is clear from some of the answers given throughout the evaluation, that some women were no longer engaged in the platform. Their responses were useful in forming recommendations to improve the initiative and provide balance to the conversation about the usefulness of CCC.

Recommendations
1)	Use specific health messaging to encourage women to join the Capital Chicks CANberra (CCC) initiative based on the three top reasons why women were prompted to join.  These top reasons should also be reflected in the content created and published by CCC.
2)	Tailor interventions to be specific to a variety of women’s circumstances. More investigation is needed to identify nuanced needs of women.
3)	To expand and reach a wider audience, a diverse range of digital marketing and other traditional means should be employed.
4)	Continue to provide content that women are going to use, such as recipes and workout videos, while also giving them choice to use what they need, to improve awareness and to help women identify and implement behaviour change.
5)	Provide information on key topics, such as lifestyle factors that influence gestational and type 2 diabetes, on areas of the platform that are most frequently accessed to ensure that women have a greater awareness of those topics.
6)	Promote specific aspects of the platform and their usefulness to improve women’s awareness. 
7)	Promote and provide opportunities to connect with local women with similar health goals.
o	More investigation is needed to explore why women are not connecting or utilising the tools available on the platform to connect with local women.
8)	Improve the useability of the website and application technology by doing further investigation into the specific areas highlighted by women.

References
Dennison R A, Ward, R J, Griffin, J S & Usher-Smith J A, ‘Women's views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice’, Diabetic Medicine, vol 36, no. 6, 2019, pp. 702-717.
Hoban E, ACT women’s health matters! ACT women’s views about their health; their health needs; their access to services, supports and information; and the barriers to maintaining their health, Women’s Centre for Health Matters, Canberra, 2018.
Hutchison A, Physical activity and healthy eating promotion to ACT women. A guide to getting it right, Women’s Centre for Health Matters, Canberra, 2018.
Kim C, Newton K M, Knopp R H, ‘Gestational diabetes and the incidence of type 2 diabetes: a systematic review’, Diabetes Care, 2002, vol. 25, no. 10, pp.1862-8.
Statista, Facebook users by age Australia 2019, retrieved on the 23rd of May 2021; https://www.statista.com/statistics/680581/australia-facebook-users-by-age/

Vounzoulaki E, Khunti K, Aner S C, Tan B K, Davies M J, & Gillies C L, ‘Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis’, BMJ, 2020, vol. 369, pp. 1-11.