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Wimmelmann CL, Sejling C, Clarke RB, Elsenburg LK, Sørensen TIA, Rod NH. Childhood adversity trajectories and weight status in young adult men: a register-based study including 359,783 Danish men. Int J Obes (Lond) 2024; 48:1157-1163. [PMID: 38816565 PMCID: PMC11281903 DOI: 10.1038/s41366-024-01540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Childhood adversity has previously been associated with overweight and obesity in adult life, but there is a need for larger population-based studies using prospectively obtained adversity trajectories across childhood to confirm these associations. Moreover, childhood adversity may also be associated with underweight, which is less often studied. The aim of the current study is to investigate the association between childhood adversity trajectories from 0-15 years with weight categories in young adult men. METHODS The Danish Life Course Cohort (DANLIFE) was linked with the Danish Conscription Registry resulting in a study sample of 359,783 men, who have been assigned to one of five previously identified adversity trajectories from 0-15 years: "low adversity", "early material deprivation", "persistent material deprivation", "loss or threat of loss", and "high adversity". Height and weight in young adulthood was assessed at a draft board examination at age 18-26 years. Associations of adversity trajectories and weight categories were investigated in multinomial regression models. RESULTS Compared with the "low adversity" group, the four other adversity groups had higher risks of underweight, overweight, and obesity. The "high adversity" group showed the strongest associations with both underweight (1.44 (1.32, 1.58)) and obesity (1.50 (1.39, 1.61)) when adjusted for parental origin, birth year, age at draft board examination, and maternal age. CONCLUSION Childhood adversity, experienced between 0 and 15 years of life, was associated with a higher risk of underweight, overweight, and obesity in young adulthood among men.
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Affiliation(s)
- Cathrine L Wimmelmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark.
- Centre for Childhood Health, Islands Brygge 41, 2300 Copenhagen S, Copenhagen, Denmark.
| | - Christoffer Sejling
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
| | - Rebecca B Clarke
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
| | - Leonie K Elsenburg
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
| | - Thorkild I A Sørensen
- Centre for Childhood Health, Islands Brygge 41, 2300 Copenhagen S, Copenhagen, Denmark
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
- Section on Genomic Physiology and Translation, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Copenhagen, Denmark
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5A, Copenhagen, Denmark
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Whitten T, Tzoumakis S, Green MJ, Dean K. Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review and Proportional Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:1411-1430. [PMID: 37300288 PMCID: PMC10913340 DOI: 10.1177/15248380231179133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Efforts to identify and prevent childhood exposure to physical violence within domestic and family relationships must be underpinned by reliable prevalence estimates to ensure the appropriate allocation of resources and benchmarks for assessing intervention efficacy. We conducted a systematic review and meta-analysis of the global prevalence of childhood exposure to physical domestic and family violence separately as a victim or witness. Searches were conducted in Criminal Justice Abstracts, Embase, Scopus, PubMed, PsychInfo, and Google Scholar. Studies were included if they were peer-reviewed, published in English, had a representative sample, unweighted estimates, and were published between January 2010 and December 2022. One-hundred-and-sixteen studies comprising 56 independent samples were retained. Proportional meta-analysis was conducted to calculate the pooled prevalence for each exposure. Pooled prevalence estimates were also stratified by region and sex. The global pooled prevalence of childhood exposure to physical domestic and family violence as a victim or witness was 17.3% and 16.5%, respectively. Prevalence estimates were highest in West Asia and Africa (victim = 42.8%; witness = 38.3%) and lowest for the Developed Asia Pacific region (victim = 3.7%; witness = 5.4%). Males were 25% more likely than females to be the victim of physical domestic and family violence during childhood, while both were equally likely to have witnessed it. These findings suggest that childhood exposure to domestic and family violence is relatively common, affecting around one-in-six people by 18 years of age globally. Regional variations in prevalence estimates may reflect underlying economic conditions, cultural norms, and service availability.
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Affiliation(s)
- Tyson Whitten
- Center for Law and Justice, Charles Sturt University, Port Macquarie, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
| | - Stacy Tzoumakis
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
- School of Criminology and Criminal Justice, Griffith University, Southport, Queensland, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Melissa J. Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
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Wang X, Jiang L, Barry L, Zhang X, Vasilenko SA, Heath RD. A Scoping Review on Adverse Childhood Experiences Studies Using Latent Class Analysis: Strengths and Challenges. TRAUMA, VIOLENCE & ABUSE 2024; 25:1695-1708. [PMID: 37594222 DOI: 10.1177/15248380231192922] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Adverse childhood experiences (ACEs) studies reveal the profound impacts of experiencing trauma and hardships in childhood. However, the cumulative risk approach of treating ACEs obscures the heterogeneity of ACEs and their consequences, making actionable interventions impossible. latent class analysis (LCA) has increasingly been used to address these concerns by identifying underlying subgroups of people who experience distinctive patterns of co-occurring ACEs. Though LCA has its strengths, the existing research produces few comparable findings because LCA results are dependent on ACEs measures and indicators, which vary widely by study. Therefore, a scoping review of ACEs studies using LCA that focuses on ACEs measures, indicators, and findings is needed to inform the field. Following Arksey and O'Malley's five-stage scoping review methodological framework, we first identified 211 articles from databases of EBSCOhost, PubMed, and Scopus using "adverse childhood experiences" for title search and "latent class analysis" for abstract search. Based on the inclusion criteria of peer-reviewed articles written in English published from 2012 to 2022 and the exclusion criteria of nonempirical studies and the LCA not analyzing ACEs, we finally selected 58 articles in this scoping review. Results showed LCA has been increasingly endorsed in the ACEs research community to examine the associations between ACEs and human health and well-being across culturally diverse populations. LCA overcame the limitations of the traditional methods by revealing specific ACEs clusters that exert potent effects on certain outcomes. However, the arbitrary nature of selecting ACEs indicators, measures, and the limited use of theory impedes the field from moving forward.
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Tolonen I, Saarinen A, Sebert S, Hintsanen M. Do compassion and self-compassion moderate the relationship between childhood socioeconomic position and adulthood body composition? Psychol Health 2024:1-20. [PMID: 38270065 DOI: 10.1080/08870446.2024.2305133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
The study aims to investigate the associations of compassion and self-compassion with body composition, and whether adulthood compassion and self-compassion moderate the relationship between childhood SEP and adulthood body composition. The participants came from the Northern Finland Birth Cohort 1986 Study (n = 789, 52.1% women), with a mean age of 34.0 years. Compassion and self-compassion were measured with the Dispositional Positive Emotions Scale and Self-Compassion Scale-Short Form, respectively. Body composition was assessed using anthropometric and body fat measurements at a clinic. Childhood SEP included parental occupation, education, and employment. The results showed that high compassion was associated with three out of the five body composition measurements, namely lower waist circumference (B = -0.960, p = 0.039, 95% CI: -1.870; -0.498), body fat percentage (B = -0.693, p = 0.030, 95% CI: -1.317; -0.069), and fat mass index (B = -0.325, p = 0.023, 95% CI: -0.605; -0.044) (adjusted for sex, and childhood and adulthood SEP) but not with body mass index or waist-to-hip ratio. Self-compassion was not associated with body composition. Neither compassion nor self-compassion moderated the association between childhood SEP and adulthood body composition, as the interaction effects were not significant. Therefore, the dispositions did not protect against the negative effects of childhood SEP on adulthood body composition. High other-directed compassion may be, however, associated with healthier body composition.
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Affiliation(s)
- Iina Tolonen
- Division of Psychology, VISE, Faculty of Education and Psychology, University of Oulu, Oulu, Finland
| | - Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Sylvain Sebert
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mirka Hintsanen
- Division of Psychology, VISE, Faculty of Education and Psychology, University of Oulu, Oulu, Finland
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Yoon C, Joseph T, Moussa G, Voss T, Ledoux T, Johnston C. Associations of positive childhood experiences with binge-eating disorder characteristics and intuitive eating among college students. Appetite 2023; 191:107073. [PMID: 37802219 DOI: 10.1016/j.appet.2023.107073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/08/2023]
Abstract
Childhood experiences encompass both adverse and positive childhood events. Adverse childhood experiences are positively associated with binge-eating disorder characteristics and inversely associated with intuitive eating in adults. However, to what extent positive childhood experiences (PCEs) are associated with binge-eating disorder characteristics and intuitive eating remains unclear. This study examined the associations of cumulative and individual PCEs with binge-eating disorder characteristics and intuitive eating among college students. Data were collected from 828 college students in 2022 (54.5% female, Mage 20.9 ± 2.6 years). PCEs were assessed using the Benevolent Childhood Experiences scale. Binge-eating disorder characteristics were assessed with the Questionnaire on Eating and Weight Patterns-5. Intuitive eating was assessed with the Intuitive Eating Scale-2. Associations of PCEs with binge-eating disorder characteristics and intuitive eating were examined using modified Poisson regressions and linear regressions. PCEs were cumulatively associated with binge-eating disorder characteristics and intuitive eating (p for trend <.05). College students in the low PCEs category (0-4 PCEs) had 1.37-1.92 times the prevalence of binge-eating disorder characteristics and had 3.89 points lower intuitive eating score than those in the high PCEs category (9-10 PCEs). Among the individual PCEs, intrapersonal PCE (i.e., feeling comfortable with oneself during childhood) was associated with both a lower prevalence of binge-eating disorder characteristics (aPR = 0.56-0.76) and a higher score of intuitive eating (adjusted β = 1.87, 95% CI = 1.28-2.46) after adjustment for sociodemographic variables. Findings from this study suggest that PCEs may play a role in eating behaviors of college students. Future studies with nationally representative samples should prospectively examine associations of PCEs with binge-eating disorder characteristics and intuitive eating and explore the underlying mechanisms of the associations between PCEs and eating behaviors.
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Affiliation(s)
- Cynthia Yoon
- Department of Health and Human Performance, University of Houston, Houston, TX, 77204, USA.
| | - Temperance Joseph
- School of Public Health, The University of Texas Health Sciences Center at Houston, Houston, TX, 77030, USA
| | - Genesis Moussa
- Department of Health and Human Performance, University of Houston, Houston, TX, 77204, USA
| | - Trenton Voss
- Department of Health and Human Performance, University of Houston, Houston, TX, 77204, USA
| | - Tracey Ledoux
- Department of Health and Human Performance, University of Houston, Houston, TX, 77204, USA
| | - Craig Johnston
- Department of Health and Human Performance, University of Houston, Houston, TX, 77204, USA
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Larson N, Mason SM, Bruening M, Laska MN, Hazzard VM, Neumark-Sztainer D. Adverse childhood experiences and food insecurity in emerging adulthood: findings from the EAT 2010-2018 study. Public Health Nutr 2023; 26:2343-2354. [PMID: 37431646 DOI: 10.1017/s1368980023001349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Low childhood socio-economic status (SES) and adverse childhood experiences (ACE) are associated with poor health outcomes in adulthood. Determining how ACE may be linked to food insecurity among young people from socio-economically diverse households can inform health-protective strategies. This study examined if ACE are associated with food insecurity during the transition to adulthood and investigated prevalence differences across SES strata. SETTING Participants were recruited from twenty secondary schools in Minneapolis-St. Paul, Minnesota. PARTICIPANTS The analytic sample (n 1518) completed classroom surveys in 2009-2010 (mean age = 14·5 years) and follow-up surveys in 2017-2018 (mean age = 22·0 years). DESIGN Past-year food insecurity was reported at both time points, and ACE were reported at follow-up. Logistic regression models were used to estimate emerging adult food insecurity prevalence by ACE exposure; models were stratified by childhood SES (low, middle and high). RESULTS The adjusted prevalence of food insecurity was 45·3 % among emerging adults who reported three or more ACE compared with 23·6 % among those with one or two ACE and 15·5 % among those with no ACE (P < 0·001). All forms of ACE were related to an elevated prevalence of food insecurity in emerging adulthood. ACE-food insecurity associations were strongest for emerging adults from lower and middle SES households. Among emerging adults from low SES households, childhood experiences of emotional abuse and substance use by a household member were associated with the largest prevalence differences in food insecurity. CONCLUSIONS Findings suggest a need for trauma-informed services within food assistance programs to better serve individuals with a history of ACE.
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Affiliation(s)
- Nicole Larson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN55454, USA
| | - Susan M Mason
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN55454, USA
| | - Meg Bruening
- Department of Nutritional Sciences, College of Health and Human Development, Penn State, 110 Chandlee Lab, University Park, PA16802, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN55454, USA
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN55454, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 South Second Street, Minneapolis, MN55454, USA
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Zhu Y, Zhan S, Anme T, Zhang G. Maternal adverse childhood experiences and behavioral problems in Chinese preschool children: The moderated mediating role of emotional dysregulation and self-compassion. CHILD ABUSE & NEGLECT 2023; 141:106226. [PMID: 37150119 DOI: 10.1016/j.chiabu.2023.106226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The negative effects of maternal adverse childhood experiences (ACEs) may have a direct intergenerational effect on a child's behavior. This topic has been widely examined, but few studies have explored the underlying mechanism and protective factors influencing maternal ACEs and offspring's behavioral problems in the Chinese context. OBJECTIVE This study aims to investigate the mediating effect of emotional dysregulation on the relationship between maternal ACEs and offspring behavior and examine whether self-compassion can moderate this association. PARTICIPANTS AND SETTING The participants were 2282 preschoolers (52 % male) with a mean age of M = 62.63 months (SD = 9.28) and their mothers. They were from northern, central, and southern Anhui Province China, and data were collected in relation to the family's socioeconomic status by population density of children in the region. METHODS Data were collected from the mothers with respect to maternal ACEs, emotional dysregulation, and self-compassion. Mothers provided information regarding children's behavior and demographic characteristics. A moderated mediation model was analyzed through SPSS. RESULTS First, the presence of maternal ACEs was positively associated with offspring behavioral problems. Second, maternal emotional dysregulation mediated the relationship between ACEs and offspring behavioral problems. Third, mothers' self-compassion moderated the indirect relationship between ACEs and offspring behavioral problems via emotional dysregulation. CONCLUSIONS Our findings highlight the critical role of emotional dysregulation and self-compassion in the relationship between maternal ACEs and offspring behavioral problems. Interventions should target maternal emotional dysregulation and self-compassion to minimize the risk of intergeneration transmission of negative effects.
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Affiliation(s)
- Yantong Zhu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Shuwei Zhan
- School of Education, Central China Normal University, Wuhan, China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Gengli Zhang
- Faculty of Educational Science, Anhui Normal University, Wuhu, China.
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Yoon CY, Mason SM, Loth K, Jacobs DR. Adverse childhood experiences and disordered eating among middle-aged adults: Findings from the coronary artery risk development in young adults study. Prev Med 2022; 162:107124. [PMID: 35787840 DOI: 10.1016/j.ypmed.2022.107124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
Adverse childhood experiences (ACEs) include childhood abuse, neglect, and household substance abuse. Childhood abuse is a risk factor for disordered eating (DEB). Less well established are associations of childhood neglect and household substance abuse with DEB, and little research has examined ACE associations with DEB in middle adulthood. The objective of this study was to examine associations between ACEs and DEBs among middle-aged adults and examine sex differences. ACEs prior to age 18 were retrospectively assessed in the Coronary Artery Risk Development in Young Adults study in 2000-2001 (N = 3340, ages 32 to 46). DEB outcomes (i.e., concerns about weight and shape, anxiety about eating or food, unhealthy weight control behaviors, chronic dieting, overeating, and binge eating) were assessed in 1995-1996 (ages 27 to 41). Modified Poisson regressions estimated risk ratios (RRs) for associations of a history of any ACE, each ACE, and cumulative ACEs with DEB outcomes. Among women, emotional abuse, physical neglect, and emotional neglect were each modestly associated with most DEBs (RRs = 1.21-1.35, 1.21-1.45, and 1.23-1.41 across DEBs, respectively) after adjustment for sociodemographic variables, BMI, and depressive symptoms. A cumulative ACE score was associated with all DEBs in a stepwise manner (p for trend ≤0.05) except concerns about weight and shape and overeating. Among men, emotional abuse was most consistently related to the majority of DEBs (RRs = 1.23-1.92); household substance abuse was modestly associated with overeating (RR = 1.26, 95% CI = 1.04-1.53). ACEs were cumulatively associated with unhealthy weight control behaviors, overeating, and binge eating (p for trend <0.01).
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Affiliation(s)
- Cynthia Y Yoon
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN 55454, USA; University of Houston, Department of Health and Human Performance, Houston, TX 77204, USA.
| | - Susan M Mason
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN 55454, USA
| | - Katie Loth
- University of Minnesota, Department of Family Medicine and Community Health, Minneapolis, MN 55454, USA
| | - David R Jacobs
- University of Minnesota, School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN 55454, USA
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Swindle T, Rutledge JM, Martin J, Curran GM. Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior. Implement Sci Commun 2022; 3:60. [PMID: 35668517 PMCID: PMC9171954 DOI: 10.1186/s43058-022-00307-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background The current study sought to (1) describe a new classification approach for types of implementer behavior and (2) explore the implementer behavior change in response to tailored implementation facilitation based on the classifications. Methods A small-scale, cluster-randomized hybrid type III implementation trial was conducted in 38 early care and education classrooms that were part of the Together, We Inspire Smart Eating (WISE) program. WISE focuses on 4 evidence-based practices (EBPs), which are implemented by teachers to promote nutrition. External facilitators (N = 3) used a modified Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) to complete immersion (i.e., observations) and thematic content analyses of interviews to identify the characteristics of teachers’ behavior at varying levels of implementation fidelity. Three key factors—attitudes toward the innovation, fidelity/adaptations, and influence—were identified that the research team used to classify teachers’ implementation behavior. This process resulted in a novel classification approach. To assess the reliability of applying the classification approach, we assessed the percent agreement between the facilitators. Based on the teachers’ classification, the research team developed a tailored facilitation response. To explore behavior change related to the tailored facilitation, change in fidelity and classification across the school year were evaluated. Results The classifications include (1) enthusiastic adopters (positive attitude, meeting fidelity targets, active influence), (2) over-adapting adopters (positive attitude, not meeting fidelity targets, active influence), (3) passive non-adopters (negative attitude, not meeting fidelity targets, passive influence), and (4) active non-adopters (negative attitudes, not meeting fidelity targets, active influence). The average percent agreement among the three facilitators for classification was 75%. Qualitative data support distinct patterns of perceptions across the classifications. A positive shift in classification was observed for 67% of cases between the mid-point and final classification. Finally, we generated an expanded classification approach to consider additional combinations of the three factors beyond those observed in this study. Conclusions Data from this study support the ability to apply the classification approach with moderate to high reliability and to use the approach to tailor facilitation toward improved implementation. Findings suggest the potential of our approach for wider application and potential to improve tailoring of implementation strategies such as facilitation.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR, 72205-7199, USA.
| | - Julie M Rutledge
- Education and Research in Children's Health Center, College of Applied and Natural Sciences, Louisiana Tech University, Ruston, USA
| | - Janna Martin
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR, 72205-7199, USA
| | - Geoffrey M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, #522-472205-7199, USA.,Central Arkansas Veterans Healthcare System, 4300 W 7th St, Little Rock, AR, 72205, USA
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