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Baticulon RE, Dewan MC, Karekezi C, Shlobin NA, Garcia RM, Ghotme KA, Thango N, Rosseau G, Hutchinson PJ. Achieving Equity Through Global Neurosurgery Research. Neurosurgery 2024:00006123-990000000-01319. [PMID: 39185879 DOI: 10.1227/neu.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/13/2024] [Indexed: 08/27/2024] Open
Abstract
Since the release of the Lancet Commission on Global Surgery report in 2015, there has been an increase in the number of published papers on global neurosurgery, gaining widespread support from major neurosurgery journals. However, there remains no consensus on what may be considered part of global neurosurgery literature. Here, we propose that global neurosurgery research encompasses all scholarly work that measure, explore, or address inequity in the care of neurosurgical disease. We describe the growth of global neurosurgery research, cite landmark papers, and discuss barriers to participation, particularly among neurosurgeons in low- and middle-income countries. We introduce the 3Rs framework, advocating for global neurosurgery research that is rigorous, responsive, and responsible. This narrative review aims to guide young neurosurgeons and other researchers interested in the field, and to provide a framework through which global neurosurgery practitioners and advocates can evaluate previously accomplished work, paving the way toward neurosurgery that is timely, safe, and affordable to all.
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Affiliation(s)
- Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Michael C Dewan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, University of Rwanda, Kigali, Rwanda
| | - Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Roxanna M Garcia
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kemel A Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
- Neurosurgery Department, Fundacion Santa Fe De Bogota, Bogota, Colombia
| | - Nqobile Thango
- Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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Lee K, Bauman A, Wolfenden L, Phongsavan P, Crane M. How long does it take to scale-up obesity prevention interventions? Prev Med 2024; 185:108012. [PMID: 38821419 DOI: 10.1016/j.ypmed.2024.108012] [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: 02/04/2024] [Revised: 05/06/2024] [Accepted: 05/25/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE The scale-up of evidence-based interventions is necessary to reverse high rates of obesity. However, scale-up doesn't occur frequently nor in a timely manner. While it has been estimated that takes 14-17 years for research translation to occur, the time taken to scale-up prevention interventions is largely unknown. This study examined the time taken to scale-up obesity prevention interventions across four scale-up pathways. METHODS A sample of obesity prevention interventions that had been scaled-up or implemented at scale were found using a structured search strategy. Included interventions were mapped against four scale-up pathways and timeframes associated with each stage of the scale-up pathway were identified to determine the time taken to scale-up. RESULTS Of the 90 interventions found that were scaled-up to at least a city-wide level, less than half reported a comprehensive research pathway to scale-up and a third did not report any evidence of efficacy or effectiveness prior to scale-up. The time taken to scale-up ranged from 0 to 5 years depending on the pathway taken. Those following a comprehensive pathway took approximately 5 years to scale-up, while interventions that had only one evidence generating step took between 1 and 1.5 years to scale-up. For the remaining interventions, scale-up occurred immediately post-development without evidence generation. CONCLUSIONS Our findings indicate that the scale-up of obesity prevention interventions can occur more quickly than previous estimates of 14-17 years. Our findings support previous research that scale-up of interventions occurs through a variety of pathways and often scale-up occurs in absence of prior evidence of effectiveness.
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Affiliation(s)
- Karen Lee
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
| | - Adrian Bauman
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
| | - Luke Wolfenden
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia; The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Philayrath Phongsavan
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
| | - Melanie Crane
- Sydney School of Public Health, The University of Sydney, NSW 2006, Australia; Charles Perkins Centre, The University of Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia.
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McKay HA, Kennedy SG, Macdonald HM, Naylor PJ, Lubans DR. The Secret Sauce? Taking the Mystery Out of Scaling-Up School-Based Physical Activity Interventions. J Phys Act Health 2024; 21:731-740. [PMID: 38936808 DOI: 10.1123/jpah.2024-0274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 06/29/2024]
Abstract
Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.
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Affiliation(s)
- Heather A McKay
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sarah G Kennedy
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Heather M Macdonald
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, BC, Canada
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Tiendrebeogo J, Arnold B, Ouedraogo Y, Haws R, Garane LP, Ouedraogo V, Gouem M, Coulibaly A, Bougma M. Mobilizing stakeholders for implant removals in Burkina Faso using landscape assessment data. BMC Womens Health 2024; 24:301. [PMID: 38769558 PMCID: PMC11104007 DOI: 10.1186/s12905-024-03121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/29/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Successful efforts to encourage uptake of subdermal contraceptive implants, with a lifespan of three to five years, necessitate planning to ensure that quality removal services are available when desired. In Burkina Faso, implant use has tripled over the past 8 years and now comprises almost half of the contraceptive method mix. Population Monitoring for Action (PMA) surveys identified barriers to obtaining quality removal when desired, particularly when the implant is not palpable, or providers lack needed skills or supplies. The Expanding Family Planning Choices (EFPC) project supported ministries of health in four countries with evaluation and strengthening of implant removal services. METHODS An implant removal landscape assessment was conducted at 24 health facilities in three regions of Burkina Faso with high implant use that included provider observations of implant removal, interviews with providers and health facility managers, and facility readiness surveys. The project used landscape data to mobilize stakeholders through a series of participatory workshops to develop a collaborative roadmap and commit to actions supporting quality implant removals. RESULTS Landscape findings revealed key gaps in provision of quality removal services, including high levels of provider confidence for implant insertion and removal (82% and 71%, respectively), low competence performing simple and difficult removals (19.2% and 11.1%, respectively), inadequate supplies and equipment (no facilities had all necessary materials for removal), lack of difficult removal management systems, and a lack of standard data collection tools for removal. Exposure to the data convinced stakeholders to focus on removals rather than expanding insertion services. While not all roadmap commitments were achieved, the process led to critical investments in quality implant removals. CONCLUSION Landscape data revealed that facilities lack needed supplies and equipment, and providers lack skills needed to perform quality implant removals, limiting client reproductive choice. Disseminating this data enabled stakeholders to identify and commit to evidence-based priority actions. Stakeholders have since capitalized on program learnings and the roadmap, including following MOH guidance for implant removal supplies and health provider training. Our experience in Burkina Faso offers a replicable model of how data can direct collective action to improve quality of contraceptive implant removals.
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Affiliation(s)
| | | | | | - Rachel Haws
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Maria Gouem
- Jhpiego Burkina Faso, Ouagadougou, Burkina Faso
| | | | - Mathieu Bougma
- Ministère de la Santé [Ministry of Health] Burkina Faso, Ouagadougou, Burkina Faso
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Wolfenden L, Hall A, Bauman A, Milat A, Hodder R, Webb E, Mooney K, Yoong S, Sutherland R, McCrabb S. Research outcomes informing the selection of public health interventions and strategies to implement them: A cross-sectional survey of Australian policy-maker and practitioner preferences. Health Res Policy Syst 2024; 22:58. [PMID: 38745326 PMCID: PMC11095011 DOI: 10.1186/s12961-024-01144-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A key role of public health policy-makers and practitioners is to ensure beneficial interventions are implemented effectively enough to yield improvements in public health. The use of evidence to guide public health decision-making to achieve this is recommended. However, few studies have examined the relative value, as reported by policy-makers and practitioners, of different broad research outcomes (that is, measures of cost, acceptability, and effectiveness). To guide the conduct of research and better inform public health policy and practice, this study aimed at describing the research outcomes that Australian policy-makers and practitioners consider important for their decision-making when selecting: (a) public health interventions; (b) strategies to support their implementation; and (c) to assess the differences in research outcome preferences between policy-makers and practitioners. METHOD An online value-weighting survey was conducted with Australian public health policy-makers and practitioners working in the field of non-communicable disease prevention. Participants were presented with a list of research outcomes and were asked to select up to five they considered most critical to their decision-making. They then allocated 100 points across these - allocating more points to outcomes perceived as more important. Outcome lists were derived from a review and consolidation of evaluation and outcome frameworks in the fields of public health knowledge translation and implementation. We used descriptive statistics to report relative preferences overall and for policy-makers and practitioners separately. RESULTS Of the 186 participants; 90 primarily identified as policy-makers and 96 as public health prevention practitioners. Overall, research outcomes of effectiveness, equity, feasibility, and sustainability were identified as the four most important outcomes when considering either interventions or strategies to implement them. Scores were similar for most outcomes between policy-makers and practitioners. CONCLUSION For Australian policy-makers and practitioners working in the field of non-communicable disease prevention, outcomes related to effectiveness, equity, feasibility, and sustainability appear particularly important to their decisions about the interventions they select and the strategies they employ to implement them. The findings suggest researchers should seek to meet these information needs and prioritize the inclusion of such outcomes in their research and dissemination activities. The extent to which these outcomes are critical to informing the decision of policy-makers and practitioners working in other jurisdictions or contexts warrants further investigation.
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Affiliation(s)
- Luke Wolfenden
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.
| | - Alix Hall
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Adrian Bauman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Australian Prevention Partnership Centre, Sydney, NSW, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Rebecca Hodder
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Emily Webb
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
| | - Kaitlin Mooney
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
| | - Serene Yoong
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, 3122, Australia
- Global Nutrition and Preventive Health, Institute of Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Rachel Sutherland
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Sam McCrabb
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
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Tyagi S, Koh GCH, Lee ES, Ong KP, Heng R, Er LH, Oh E, Teo V, Ng DWL. Primary Technology Enhanced Care Home HbA1c Testing (PTEC HAT) programme: a feasibility pilot study in Singapore. BMC PRIMARY CARE 2024; 25:127. [PMID: 38654201 PMCID: PMC11040893 DOI: 10.1186/s12875-024-02373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Considering time-consuming, cost-related limitations of laboratory-based HbA1c testing and follow-up clinic visits for diabetes management, it is important to explore alternative care models which incorporate point-of-care testing for HbA1c to monitor glycaemic control and related management. METHODS Therefore, we adopted an implementation perspective to conduct one group pre- and post-intervention feasibility pilot assessing feasibility, acceptability and satisfaction with conducting home HbA1c test by patients with type 2 diabetes coupled with telemonitoring and teleconsultations (i.e., the Primary Technology Enhanced Care (PTEC) Home HbA1c Testing (HAT) Programme) in Singaporean primary care setting. The secondary objective was to compare the HbA1c, blood pressure and primary care visits at the end or during intervention, vs. 6 months before. Adult patients with type 2 diabetes with HbA1c ≤ 8% without any diabetes complications and having phone compatibility were recruited. Data was collected via patient self-reports and electronic medical records extraction. While summary statistics and paired t-test were computed for quantitative data, open-ended feedback was analysed using content analysis. RESULTS A total of 33 participants completed the intervention out of 37 (33/37 = 89%) recruited from 73 eligible (37/73 = 51%). Most were either 51 to 60 years old (46.9%) or more than 60 years (37.5%), with more males (53.1%) and majority Chinese (93.8%). Majority (81.3%) felt that home HbA1c testing was beneficial with most commonly reported benefit of not having a clinic visit. A key finding was the average of diabetes-related visits being significantly lower post-intervention with comparable HbA1c values pre- and post-intervention. The most commonly reported challenge was using Bluetooth to transmit the reading (43.7%), followed by having too many steps to remember (28.1%). While participants reported being overall satisfied with the intervention, only 22% were willing to pay for it. CONCLUSION Our findings support home HbA1c testing by patients coupled with telemonitoring and teleconsultations. Following are practical recommendations for the implementation scaling phase: offering PTEC HAT Programme to suitable patients who are self-motivated and have adequate digital literacy, provision of adequate educational and training support, sending reminders and exploring enabling manual submission of HbA1c readings considering Bluetooth-related challenges.
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Affiliation(s)
- Shilpa Tyagi
- MOH Office for Healthcare Transformation (MOHT), Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- MOH Office for Healthcare Transformation (MOHT), Singapore, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Eng Sing Lee
- MOH Office for Healthcare Transformation (MOHT), Singapore, Singapore
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Kah Pieng Ong
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Roy Heng
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Lian Hwa Er
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Evonne Oh
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Valerie Teo
- National Healthcare Group Polyclinics, Singapore, Singapore
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Vinko M, Lesnik T, Radoš Krnel S. Evaluator's alignment as an important indicator of adequacy of the criteria and assessment procedure for recognizing the good practice in public health. Front Public Health 2024; 12:1286509. [PMID: 38711770 PMCID: PMC11070485 DOI: 10.3389/fpubh.2024.1286509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/27/2024] [Indexed: 05/08/2024] Open
Abstract
Background Public health interventions aim to reduce the burden of chronic non-communicable diseases. Implementing evidence-based interventions that are proven to be successful and effective is widely recognized as the best approach to addressing public health challenges. To avoid the development and implementation of less effective or successful or even harmful practices, clear criteria for the assessment of practices, that consider different dimensions of the interventions in public health, are needed. The main aim of the research was to test our Criteria and assessment procedure for recognizing good practices in the field of public health by estimating the consistency between the evaluators and thereby gaining insight into the adequacy and reliability of the criteria as well as to check how the evaluators understand the criteria and methodology and if it is properly used in assessing the interventions. Methods The assessment of the interventions took place from 2021 to 2022. The individual evaluator's scores on the scale from 1 to 5 for each specific sub-criterion were collected, which was followed by a panel discussion to reach a final score for each sub-criterion. The inter-rater agreement was measured using percent overall agreement and Fleiss' kappa coefficient. Results We found moderate inter-rater agreement on the level of the assessment criteria group. The lowest agreement was observed for the effectiveness and efficiency sub-criteria group, which also received the lowest scores from the evaluators. Challenges identified with the scoring process were due to the descriptive 1 to 5 scale and the varying specificity of the criteria. Conclusion The results showed that studying consistency between evaluators can highlight areas for improvement or adjustment in the assessment criteria and enhance the quality of the assessment instrument. Therefore, such analysis would be useful part of both newly and well-established health promotion and prevention program registries.
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Affiliation(s)
- Matej Vinko
- National Institute of Public Health, Ljubljana, Slovenia
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Barnes C, Jones J, Wolfenden L, Robertson K, Seidler AL, Norman J, Budgen P, Mattingly M, Piliskic C, Moorhouse L, Mozina J, Plaskett J, McDermott S, Darney S, Vuong C, Douglass N, McDonnell K, Sutherland R. A collaborative network trial to evaluate the effectiveness of implementation strategies to maximize adoption of a school-based healthy lunchbox program: a study protocol. Front Public Health 2024; 12:1367017. [PMID: 38601495 PMCID: PMC11004312 DOI: 10.3389/fpubh.2024.1367017] [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: 01/08/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction An important impediment to the large-scale adoption of evidence-based school nutrition interventions is the lack of evidence on effective strategies to implement them. This paper describes the protocol for a "Collaborative Network Trial" to support the simultaneous testing of different strategies undertaken by New South Wales Local Health Districts to facilitate the adoption of an effective school-based healthy lunchbox program ('SWAP IT'). The primary objective of this study is to assess the effectiveness of different implementation strategies to increase school adoption of the SWAP across New South Wales Local Health Districts. Methods Within a Master Protocol framework, a collaborative network trial will be undertaken. Independent randomized controlled trials to test implementation strategies to increase school adoption of SWAP IT within primary schools in 10 different New South Wales Local Health Districts will occur. Schools will be randomly allocated to either the intervention or control condition. Schools allocated to the intervention group will receive a combination of implementation strategies. Across the 10 participating Local Health Districts, six broad strategies were developed and combinations of these strategies will be executed over a 6 month period. In six districts an active comparison group (containing one or more implementation strategies) was selected. The primary outcome of the trial will be adoption of SWAP IT, assessed via electronic registration records captured automatically following online school registration to the program. The primary outcome will be assessed using logistic regression analyses for each trial. Individual participant data component network meta-analysis, under a Bayesian framework, will be used to explore strategy-covariate interactions; to model additive main effects (separate effects for each component of an implementation strategy); two way interactions (synergistic/antagonistic effects of components), and full interactions. Discussion The study will provide rigorous evidence of the effects of a variety of implementation strategies, employed in different contexts, on the adoption of a school-based healthy lunchbox program at scale. Importantly, it will also provide evidence as to whether health service-centered, collaborative research models can rapidly generate new knowledge and yield health service improvements. Clinical trial registration This trial is registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12623000558628).
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Affiliation(s)
- Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, Australia
| | - Jannah Jones
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, Australia
| | - Katie Robertson
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Jennifer Norman
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Pip Budgen
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Megan Mattingly
- Health Promotion, Murrumbidgee Local Health District, Albury, NSW, Australia
| | - Carla Piliskic
- Health Promotion Unit, Population Health, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Lisa Moorhouse
- Health Equity, Promotion and Prevention Service, South Eastern Sydney Local Health District, Darlinghurst, NSW, Australia
| | - Jennifer Mozina
- Population Health, Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - Jennifer Plaskett
- Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Sarah McDermott
- Centre for Population Health, Western Sydney Local Health District, North Parramatta, NSW, Australia
| | - Sara Darney
- Western NSW Health Promotion, Western NSW Local Health District, Dubbo, NSW, Australia
| | - Cecilia Vuong
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Nina Douglass
- Health Promotion Service, Central Coast Local Health District, Gosford, NSW, Australia
| | - Kara McDonnell
- Population Health Promotion, Northern Sydney Local Health District, Brookvale, NSW, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, Australia
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Lim GP, Appalasamy JR, Ahmad B, Quek KF, Ramadas A. Peer-led lifestyle interventions for the primary prevention of cardiovascular disease in community: a systematic review of randomised controlled trials. BMC Public Health 2024; 24:812. [PMID: 38486215 PMCID: PMC10941612 DOI: 10.1186/s12889-024-18328-w] [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: 09/15/2023] [Accepted: 03/11/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Peer-led lifestyle interventions have gained recognition as effective approaches for managing and preventing chronic diseases. However, there remains a critical knowledge gap regarding the impact and effectiveness of peer-led interventions specifically in the primary prevention of cardiovascular disease (CVD). Our systematic review aims to synthesise the available evidence and evaluate the impact of peer-led lifestyle interventions, providing invaluable insights that can guide the development of peer-led strategies for preventing CVD. METHODS Systematic database searches were conducted on Ovid Medline, Embase, Cochrane Centre for Controlled Trials, PubMed and Scopus to source peer-reviewed articles published between 2013 and 2023. Reference lists of the included publications were also manually searched. RESULTS Fourteen unique randomised controlled trials were identified, of which three were pilot studies. Most of the interventions were conducted among individuals at moderate to high risk of CVD and lasted for a year. There is a variety of components in intervention delivery, including group discussions and individual counselling. Peer leader training mostly covered intervention delivery, communication, and research-specific skills. Systolic blood pressure showed the most promising CVD-related improvement, while mixed results were found for several other dietary and lifestyle behavioural outcomes. CONCLUSION Peer-led lifestyle interventions have shown varying effectiveness in cardiovascular health outcomes. The competencies and roles of peer leaders were identified to guide future intervention development with a more comprehensive approach to the primary prevention of CVD.
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Affiliation(s)
- Geok Pei Lim
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | | | - Badariah Ahmad
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Kia Fatt Quek
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Amutha Ramadas
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Fox MT, Butler JI, Day AMB, Durocher E, Nowrouzi-Kia B, Sidani S, Maimets IK, Dahlke S, Yamada J. Healthcare providers' perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study. PLoS One 2024; 19:e0299289. [PMID: 38427646 PMCID: PMC10906905 DOI: 10.1371/journal.pone.0299289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/03/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses' and other healthcare providers' perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care. METHODS A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers. RESULTS Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses' ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p's < .007; effect sizes .58 - .68, respectively). DISCUSSION The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention's implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention. CONCLUSIONS The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care.
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Affiliation(s)
- Mary T. Fox
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Jeffrey I. Butler
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Adam M. B. Day
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Evelyne Durocher
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Souraya Sidani
- School of Nursing, York University, Toronto, Ontario, Canada
| | - Ilo-Katryn Maimets
- Steacie Science and Engineering Library, York University, Toronto, Ontario, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Janet Yamada
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
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Gogovor A, Zomahoun HTV, Ben Charif A, Ekanmian G, Moher D, McLean RKD, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Rheault N, Légaré F. Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review. Medicine (Baltimore) 2024; 103:e37079. [PMID: 38363902 PMCID: PMC10869056 DOI: 10.1097/md.0000000000037079] [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: 07/07/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. METHODS We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. RESULTS Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. CONCLUSION Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.
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Affiliation(s)
- Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
| | | | | | - Giraud Ekanmian
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - Robert K. D. McLean
- International Development Research Centre, Ottawa, ON
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, ON
| | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, NSW
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW
- The National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW
| | | | | | - Paula Rochon
- Women’s Age Lab, Women’s College Hospital, Toronto, ON
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - France Légaré
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
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Rakers M, van Hattem N, Plag S, Chavannes N, van Os HJA, Vos RC. Population health interventions for cardiometabolic diseases in primary care: a scoping review and RE-AIM evaluation of current practices. Front Med (Lausanne) 2024; 10:1275267. [PMID: 38239619 PMCID: PMC10794664 DOI: 10.3389/fmed.2023.1275267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction Cardiometabolic diseases (CMD) are the leading cause of death in high-income countries and are largely attributable to modifiable risk factors. Population health management (PHM) can effectively identify patient subgroups at high risk of CMD and address missed opportunities for preventive disease management. Guided by the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework, this scoping review of PHM interventions targeting patients in primary care at increased risk of CMD aims to describe the reported aspects for successful implementation. Methods A comprehensive search was conducted across 14 databases to identify papers published between 2000 and 2023, using Arksey and O'Malley's framework for conducting scoping reviews. The RE-AIM framework was used to assess the implementation, documentation, and the population health impact score of the PHM interventions. Results A total of 26 out of 1,100 studies were included, representing 21 unique PHM interventions. This review found insufficient reporting of most RE-AIM components. The RE-AIM evaluation showed that the included interventions could potentially reach a large audience and achieve their intended goals, but information on adoption and maintenance was often lacking. A population health impact score was calculated for six interventions ranging from 28 to 62%. Discussion This review showed the promise of PHM interventions that could reaching a substantial number of participants and reducing CMD risk factors. However, to better assess the generalizability and scalability of these interventions there is a need for an improved assessment of adoption, implementation processes, and sustainability.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Nicoline van Hattem
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sabine Plag
- Health Campus the Hague, Leiden University Medical Center, The Hague, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Hendrikus J. A. van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, The Hague, Netherlands
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Ramani-Chander A, Thrift A, van Olmen J, Wouters E, Delobelle P, Vedanthan R, Miranda JJ, Sherwood S, Teede HJ, Joshi R. Prioritising and planning scale-up research projects targeting non-communicable diseases: a mixed-method study by the Global Alliance for Chronic Diseases upscaling working group. BMJ Glob Health 2023; 8:e012804. [PMID: 37963611 PMCID: PMC10649516 DOI: 10.1136/bmjgh-2023-012804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Governments must scale-up evidence-based interventions to reduce the burden of non-communicable diseases (NCDs). Implementation research can help develop contextually appropriate strategies and optimise interventions for scale-up. We aimed to determine the priorities of the Global Alliance for Chronic Diseases (GACD) 2019 funding round for scale-up research targeting NCD interventions. The research questions were: (a) What was the purpose of the call and what were the specific issues considered by funders when supporting the selected projects? (b) How did the selected research projects align with the objectives of GACD scale-up call? METHODS We undertook a mixed-methods study to examine the projects funded by the GACD in 2019. We completed semistructured interviews with representatives from 5 out of 8 funding agencies and complemented this by reviewing project documents from 21 (78%) of the 27 funded studies. A literature review of scale-up frameworks informed the interview guide and data extraction template. The transcripts were open-coded using thematic analysis to identify critical issues for funders. Data were extracted to identify the common elements considered when planning, implementing and evaluating interventions for scale-up. RESULTS Interviews with the funders revealed three enabling themes related to scale-up: local research priorities (contextualisation through engagement), capacity building (developing knowledge base) and connections (networking opportunities). We further identified that timelines (more flexibility) and equity (funding low-income and middle-income researchers) could be considered for future funding investments. Multidisciplinary international research teams led the development of diverse studies to address funder's priorities. The detailed plans included a range of implementation frameworks to help develop contextual scale-up strategies. CONCLUSIONS Fundamental to NCD scale-up research are (1) funding opportunities that reflect the complexity and time necessary to enable contextualisation; (2) investment in building multidisciplinary research capacity and leadership and (3) better networking to encourage cohesive action and align NCD-related scale-up research activities globally.
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Affiliation(s)
- Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Amanda Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Josefien van Olmen
- Department of Family Health and Population Medicine, University of Antwerp, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, Faculty of Social Sciences, University of Antwerp, Antwerpen, Belgium
| | - Peter Delobelle
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Chronic Diseases Initiative for Africa, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Sherwood
- Fundación EkoRural, Quito, Ecuador
- Knowledge, Technology and Innovation, Wageningen University, Wageningen, Netherlands
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health India, New Delhi, India
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Breton M, Smithman MA, Lamoureux-Lamarche C, Keely E, Farrell G, Singer A, Dumas Pilon M, Bush PL, Nabelsi V, Gaboury I, Gagnon MP, Steele Gray C, Hudon C, Aubrey-Bassler K, Visca R, Côté-Boileau É, Gagnon J, Deslauriers V, Liddy C. Strategies used throughout the scaling-up process of eConsult - Multiple case study of four Canadian Provinces. EVALUATION AND PROGRAM PLANNING 2023; 100:102329. [PMID: 37329836 DOI: 10.1016/j.evalprogplan.2023.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/18/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND eConsult is a model of asynchronous communication connecting primary care providers to specialists to discuss patient care. This study aims to analyze the scaling-up process and identify strategies used to support scaling-up efforts in four provinces in Canada. METHODS We conducted a multiple case study with four cases (ON, QC, MB, NL). Data collection methods included document review (n = 93), meeting observations (n = 65) and semi-structured interviews (n = 40). Each case was analyzed based on Milat's framework. RESULTS The first scaling-up phase was marked by the rigorous evaluation of eConsult pilot projects and the publication of over 90 scientific papers. In the second phase, provinces implemented provincial multi-stakeholder committees, institutionalized the evaluation, and produced documents detailing the scaling-up plan. During the third phase, efforts were made to lead proofs of concept, obtain the endorsement of national and provincial organizations, and mobilize alternate sources of funding. The last phase was mainly observed in Ontario, where the creation of a provincial governance structure and strategies were put in place to monitor the service and manage changes. CONCLUSIONS Various strategies need to be used throughout the scaling-up process. The process remains challenging and lengthy because health systems lack clear processes to support innovation scaling-up.
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Affiliation(s)
- Mylaine Breton
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada.
| | - Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | | | - Erin Keely
- Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Gerard Farrell
- Department of Family Medicine, Memorial University, St-John, NFL, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Maxine Dumas Pilon
- Collège Québécois des Médecins de Famille, Family Medicine Center, St-Mary's Hospital, McGill University, Montréal, QC, Canada
| | - Paula Louise Bush
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | | | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | - Catherine Hudon
- Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Regina Visca
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Élizabeth Côté-Boileau
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | - Justin Gagnon
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Véronique Deslauriers
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil Campus, Longueuil, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, ON, Canada
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15
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Breton M, Lamoureux-Lamarche C, Smithman MA, Keely E, Pilon MD, Singer A, Farrell G, Bush PL, Hudon C, Cooper L, Nabelsi V, Côté-Boileau É, Gagnon J, Gaboury I, Gray CS, Gagnon MP, Visca R, Liddy C. Scaling-Up eConsult: Promising Strategies to Address Enabling Factors in Four Jurisdictions in Canada. Int J Health Policy Manag 2023; 12:7203. [PMID: 38618827 PMCID: PMC10590220 DOI: 10.34172/ijhpm.2023.7203] [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: 02/25/2022] [Accepted: 08/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Effective healthcare innovations are often not scaled up beyond their initial local context. Lack of practical knowledge on how to move from local innovations to large-system improvement hinders innovation and learning capacity in health systems. Studying scale-up processes can lead to a better understanding of how to facilitate the scale-up of interventions. eConsult is a digital health innovation that aims to connect primary care professionals with specialists through an asynchronous electronic consultation. The recent implementation of eConsult in the public health systems of four Canadian jurisdictions provides a unique opportunity to identify different enabling strategies and related factors that promote the scaling up of eConsult across jurisdictions. METHODS We conducted a narrative case study in four Canadian provinces, Quebec, Ontario, Manitoba, and Newfoundland & Labrador, over a 3-year period (2018-2021). We observed provincial eConsult committee meetings (n=65) and national eConsult forums (n=3), and we reviewed internal documents (n=93). We conducted semi-structured interviews with key actors in each jurisdiction (eg, researchers, primary care professionals, specialists, policy-makers, and patient partners) (n=40). We conducted thematic analysis guided by the literature on factors and strategies used to scale up innovations. RESULTS We identified a total of 31 strategies related to six key enabling factors to scaling up eConsult, including: (1) multi-actor engagement; (2) relative advantage; (3) knowledge transfer; (4) strong evidence base; (5) physician leadership; and (6) resource acquisition (eg, human, material, and financial resources). More commonly used strategies, such as leveraging research infrastructure and bringing together various actors, were used to address multiple enabling factors. CONCLUSION Actors used various strategies to scale up eConsult within their respective contexts, and these helped address six key factors that seemed to be essential to the scale-up of eConsult.
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Affiliation(s)
- Mylaine Breton
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
| | | | - Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, ON, Canada
| | - Maxine Dumas Pilon
- Collège québécois des médecins de famille, Family Medicine Center, St-Mary’s Hospital, McGill University, Montréal, QC, Canada
| | - Alexander Singer
- Department of Family Medicine, University of Manitoba, Winnipeg, MN, Canada
| | - Gerard Farrell
- Department of Family Medicine, Memorial University, St. John, NL, Canada
| | - Paula Louise Bush
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Catherine Hudon
- Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Lynn Cooper
- Canadian Injured Workers Alliance, Thunder Bay, ON, Canada
| | - Véronique Nabelsi
- Département des sciences administratives, Université du Québec en Outaouais, Gatineau, QC, Canada
| | | | - Justin Gagnon
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Isabelle Gaboury
- Centre de recherche Charles-Le Moyne, Université de Sherbrooke, Longueuil, QC, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum, Research Institute, Sinai Health System, University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, ON, Canada
| | | | - Regina Visca
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, ON, Canada
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McCrabb S, Hall A, McKay H, Gonzalez S, Milat A, Bauman A, Sutherland R, Wolfenden L. From trials to communities: implementation and scale-up of health behaviour interventions. Health Res Policy Syst 2023; 21:79. [PMID: 37525165 PMCID: PMC10388470 DOI: 10.1186/s12961-023-01027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 07/02/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND To maximise their potential benefits to communities, effective health behaviour interventions need to be implemented, ideally 'at scale', and are often adapted as part of this. To inform future implementation and scale-up efforts, this study broadly sought to understand (i) how often health behaviour interventions are implemented in communities, (ii) the adaptations that occur; (iii) how frequency it occurred 'at scale'; and (iv) factors associated with 'scale-up'. METHODS A cross-sectional survey was conducted of corresponding authors of trials (randomised or non-randomised) assessing the effects of preventive health behaviour interventions. Included studies of relevant Cochrane reviews served as a sampling frame. Participants were asked to report on the implementation and scale-up (defined as investment in large scale delivery by a (non)government organisation) of their intervention in the community following trial completion, adaptations made, and any research dissemination strategies employed. Information was extracted from published reports of the trial including assessments of effectiveness and risk of bias. RESULTS Authors of 104 trials completed the survey. Almost half of the interventions were implemented following trial completion (taking on average 19 months), and 54% of those were adapted prior to doing so. The most common adaptations were adding intervention components, and adapting the intervention to fit within the local service setting. Scale-up occurred in 33% of all interventions. There were no significant associations between research trial characteristics such as intervention effectiveness, risk of bias, setting, involvement of end-user, and incidence of scale-up. However the number of research dissemination strategies was positively associated to the odds of an intervention being scaled-up (OR = 1.50; 95% CI: 1.19, 1.88; p < 0.001). CONCLUSIONS Adaptation of implemented trials is often undertaken. Most health behaviour interventions are not implemented or scaled-up following trial completion. The use of a greater number of dissemination strategies may increase the likelihood of scaled up.
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Affiliation(s)
- Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.
| | - Alix Hall
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Heather McKay
- Department of Family Practice, Faculty of Medicine, University of British Colombia, Vancouver, Canada
| | - Sharleen Gonzalez
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
- NSW Ministry of Health, St Leonards, NSW, Australia
| | - Adrian Bauman
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
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Kayondo SP, Kaye DK, Nabatanzi SL, Nassuuna S, Musana O, Namagembe I, Nsanja JP, Morris J, Fawzi H, de Koning K, Kaur J, Pretty M. Challenges and opportunities from using abortion harm reduction and value clarification and attitude transformation engagements for safe abortion advocacy in Uganda. Reprod Health 2023; 20:97. [PMID: 37381001 DOI: 10.1186/s12978-023-01637-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND From 2018, the International Federation of Gynecologists and Obstetricians (FIGO) implemented the Advocating Safe Abortion project to support national obstetrics and gynecology (Obs/gyn) societies from ten member countries to become leaders of Sexual and Reproductive Health and Rights (SRHR). We share experiences and lessons learnt about using value clarification and attitude transformation (VCAT) and abortion harm reduction (AHR) as strategies for our advocacy engagements. METHODS The advocacy goal of ending abortion-related deaths followed predefined pathways from an extensive needs assessment prior to the project. These pathways were strengthening capacity of the Obs/gyn society as safe abortion advocates; establishing a vibrant network of partners; transforming social and gender norms; raising awareness of the legal and policy environment regarding abortion, and promoting the generation and use abortion data for evidence-informed policy and practice. Our advocacy targeted multiple stakeholders including media, policy makers judicio-legal, political and religious leaders, health workers and the public. RESULTS During each engagement, facilitators required audiences to identify what roles they can play along the continuum of strategies that can reduce maternal death from abortion complications. The audiences acknowledged abortion complications as a major problem in Uganda. Among the root causes for the abortion context, audiences noted absence of an enabling environment for abortion care, which was characterized by low awareness about the abortion laws and policy, restricted abortion laws, cultural and religious beliefs, poor quality of abortion care services and abortion stigma. CONCLUSION VCAT and AHR were critical in enabling us to develop appropriate messages for different stakeholders. Audiences were able to recognize the abortion context, distinguish between assumptions, myths and realities surrounding unwanted pregnancy and abortion; recognize imperative to address conflict between personal and professional values, and identify different roles and values which inform empathetic attitudes and behaviors that mitigate abortion harms. The five pathways of the theory of change reinforced each other. Using the AHR model, we delineate strategies and activities which stakeholders could use to end abortion deaths. VCAT enables critical reflection of views, beliefs and values versus professional obligations and responsibilities, and promotes active attitude and behavior change and commitment to end abortion-related deaths.
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Affiliation(s)
- Simon Peter Kayondo
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Dan Kabonge Kaye
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda.
| | | | - Susan Nassuuna
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Othiniel Musana
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Imelda Namagembe
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - John Paul Nsanja
- Association of Obstetricians and Gynecologists of Uganda, P.O. Box 11966, Kampala, Uganda
| | - Jessica Morris
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
| | - Hani Fawzi
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
| | | | - Jameen Kaur
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
| | - Matthew Pretty
- International Federation of Gynecologists and Obstetricians (FIGO), FIGO Headquarters, London, UK
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Birkholz L, Weber P, Helsper N, Kohler S, Dippon L, Rütten A, Pfeifer K, Semrau J. Multi-level stakeholders' perspectives on implementation and scaling up community-based health promotion in Germany. Health Promot Int 2023; 38:7151550. [PMID: 37140350 DOI: 10.1093/heapro/daad045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Community-based health promotion has the potential to address existing health inequities, although such approaches are scarcely scaled up. For a successful scale up, various stakeholders at different levels and sectors need to be involved. The article's aims are to assess what kind of external support communities need for implementation and to identify facilitators and barriers for scaling up community-based health promotion. Two national digital workshops were conducted in Germany with stakeholders at the community level (n = 161) and with stakeholders at the federal and state levels (n = 84). Protocols were compiled and coded using qualitative content analysis. During the first workshop, we revealed 11 themes for external support needs ('Strategic approach', 'Define & compare indicators', 'International human resource', 'Tools & Aids', 'External conduction of the assessment', 'Involvement of people in difficult life situations', 'Overview of actors', 'Moderation', 'Obtain funding', 'Quality assurance/evaluation' and 'External support'). Eleven facilitators and barriers were identified for scaling up ('Assessment and evaluation', 'Intersectoral collaboration and partnerships', 'Communication', 'Characteristics of the program', 'Political and legal conditions', 'Political support', 'Local coordinator', 'Resources', 'Participation', 'Strategic planning/methods' and 'Intermediary organization'). The identified results provide practice-based evidence on support needed for scaling up, facilitators that promote scaling up and barriers that might hinder scaling up community-based health promotion in Germany. In a next step, this practice-based evidence needs to be systematically integrated with scientific-based evidence on key components for scaling up such approaches for the development of an effective scaling-up concept.
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Affiliation(s)
- Leonie Birkholz
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Philipp Weber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Natalie Helsper
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Simone Kohler
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Lea Dippon
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Alfred Rütten
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
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Lee K, Crane M, Grunseit A, O’Hara B, Milat A, Wolfenden L, Bauman A, van Nassau F. Development and Application of the Scale-Up Reflection Guide (SRG). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6014. [PMID: 37297618 PMCID: PMC10253157 DOI: 10.3390/ijerph20116014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 06/12/2023]
Abstract
Scaling up effective interventions in public health is complex and comprehensive, and published accounts of the scale-up process are scarce. Key aspects of the scale-up experience need to be more comprehensively captured. This study describes the development of a guide for reflecting on and documenting the scale-up of public health interventions, to increase the depth of practice-based information of scaling up. Reviews of relevant scale-up frameworks along with expert input informed the development of the guide. We evaluated its acceptability with potential end-users and applied it to two real-world case studies. The Scale-up Reflection Guide (SRG) provides a structure and process for reflecting on and documenting key aspects of the scale-up process of public health interventions. The SRG is comprised of eight sections: context of completion; intervention delivery, history/background; intervention components; costs/funding strategies and partnership arrangements; the scale-up setting and delivery; scale-up process; and evidence of effectiveness and long-term outcomes. Utilization of the SRG may improve the consistency and reporting for the scale-up of public health interventions and facilitate knowledge sharing. The SRG can be used by a variety of stakeholders including researchers, policymakers or practitioners to more comprehensively reflect on and document scale-up experiences and inform future practice.
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Affiliation(s)
- Karen Lee
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
| | - Melanie Crane
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
- School of Public Health, The University of Technology Sydney, 15 Broadway, Sydney, NSW 2007, Australia
| | - Blythe O’Hara
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Andrew Milat
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
- School of Public Health, The University of Technology Sydney, 15 Broadway, Sydney, NSW 2007, Australia
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 1 Reserve Road, St. Leonards, NSW 2065, Australia
| | - Luke Wolfenden
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW 2308, Australia
| | - Adrian Bauman
- Sydney School of Public Health, The University of Sydney, Sydney, NSW 2050, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Sydney, NSW 2037, Australia
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Murphy J, Mansergh F, O'Donoghue G, van Nassau F, Cooper J, Grady C, Murphy N, Bengoechea EG, Murphy MH, Cullen B, Woods CB. Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners. Int J Behav Nutr Phys Act 2023; 20:16. [PMID: 36788567 PMCID: PMC9926412 DOI: 10.1186/s12966-023-01413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Current literature reports a gap between development of effective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from different domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in different domains from different stakeholders on the island of Ireland. METHODS Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven different physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research. RESULTS Thirty-eight participants took part in the interviews which identified factors related to 1) intervention planning and practical considerations; 2) organisational structures, staffing and resources related to delivery; 3) reflection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process. CONCLUSIONS Future research and practice needs to consider how different factors are experienced at different implementation stages and by the different stakeholder groups involved. The findings highlight multiple inter-related factors that influence the implementation and scale-up of physical activity interventions, but also identifies many strategies that can be utilised to aid future successes.
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Affiliation(s)
- Joey Murphy
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Fiona Mansergh
- Department of Health, Healthy Ireland, Block 1, Miesian Plaza, 50-58 Lower Baggot Street, Dublin, Ireland
| | - Grainne O'Donoghue
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Femke van Nassau
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jemima Cooper
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Department for Health, University of Bath, Bath, UK
| | - Caera Grady
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Niamh Murphy
- Department of Sport and Exercise Science, Waterford Institute of Technology, Waterford, Ireland
| | - Enrique Garcia Bengoechea
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Research & Innovation Unit, Sport Ireland, Dublin, Ireland
| | - Marie H Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University, Jordanstown Campus, Coleraine, UK
| | - Benny Cullen
- Research & Innovation Unit, Sport Ireland, Dublin, Ireland
| | - Catherine B Woods
- Physical Activity for Health Research Cluster, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
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Defining and measuring multimorbidity in primary care in Singapore: Results of an online Delphi study. PLoS One 2022; 17:e0278559. [PMID: 36455000 PMCID: PMC9714819 DOI: 10.1371/journal.pone.0278559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
Multimorbidity, common in the primary care setting, has diverse implications for both the patient and the healthcare system. However, there is no consensus on the definition of multimorbidity globally. Thus, we aimed to conduct a Delphi study to gain consensus on the definition of multimorbidity, the list and number of chronic conditions used for defining multimorbidity in the Singapore primary care setting. Our Delphi study comprised three rounds of online voting from purposively sampled family physicians in public and private settings. Delphi round 1 included open-ended questions for idea generation. The subsequent two rounds used questions with pre-selected options. Consensus was achieved based on a pre-defined criteria following an iterative process. The response rates for the three rounds were 61.7% (37/60), 86.5% (32/37) and 93.8% (30/32), respectively. Among 40 panellists who responded, 46.0% were 31-40 years old, 64.9% were male and 73.0% were from the public primary healthcare setting. Based on the findings of rounds 1, 2 and 3, consensus on the definition of a chronic condition, multimorbidity and finalised list of chronic conditions were achieved. For a condition to be chronic, it should last for six months or more, be recurrent or persistent, impact patients across multiple domains and require long-term management. The consensus-derived definition of multimorbidity is the presence of three or more chronic conditions from a finalised list of 23 chronic conditions. We anticipate that our findings will inform multimorbidity conceptualisation at the national level, standardise multimorbidity measurement in primary care and facilitate resource allocation for patients with multimorbidity.
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22
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Padilla-Moseley J, Blanco-Metzler A, L’Abbé MR, Arcand J. A Program Evaluation of a Dietary Sodium Reduction Research Consortium of Five Low- and Middle-Income Countries in Latin America. Nutrients 2022; 14:4311. [PMID: 36296995 PMCID: PMC9606855 DOI: 10.3390/nu14204311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
Excess dietary sodium is a global public health priority, particularly in low- and middle-income countries where rates of hypertension and cardiovascular disease are high. The International Development Research Centre funded a research consortium of five Latin American countries (LAC) to inform public health policy for dietary sodium reduction (2016-2020). The objective of this study was to determine the outcomes of this funding on short-term (e.g., research, capacity building) and intermediary outcomes (e.g., policies). A summative program evaluation was conducted, using a logic model and multiple data sources including document review, surveys and interviews. Researchers from Argentina, Costa Rica, Brazil, Peru and Paraguay produced a significant amount of scientific evidence to guide decision making on sodium policy related to its content in foods, consumer behaviors (social marketing), and the health and economic benefits of dietary reduction. A substantive number of knowledge translation products were produced. The funding enabled training opportunities for researchers who developed skills that can be scaled-up to other critical nutrients and health issues. It was unexpected that intermediary policy changes would occur, however several countries demonstrated early policy improvements derived from this research. A funded research consortium of LAC is a practical approach to invoke policy innovations.
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Affiliation(s)
- Janice Padilla-Moseley
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada
| | - Adriana Blanco-Metzler
- Costa Rican Institute of Research and Teaching in Nutrition and Health (INCIENSA), Tres Ríos P.O. Box 4-2250, Costa Rica
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada
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Sauter A, Herbert-Maul A, Abu-Omar K, Thiel A, Ziemainz H, Frahsa A, Linder S, Herrmann-Johns A. "For me, it's just a piece of freedom"-Increased empowerment through physical activity promotion among socially disadvantaged women. Front Public Health 2022; 10:867626. [PMID: 35968425 PMCID: PMC9363839 DOI: 10.3389/fpubh.2022.867626] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Community-based participatory research (CBPR) is an effective health promotion approach for reaching socially disadvantaged groups. However, there is limited evidence on how such interventions and their effects can be reproduced across time and place. The present study examines the effects of BIG (i.e., movement as an investment in health), a long-standing German CBPR project. Since 2005, BIG has aimed to empower women in difficult life situations to increase control over their health determinants and reduce social inequalities by promoting physical activity. One of BIG's key features is its implementation in several German municipalities since 2005. This study explores (a) whether participation could change women's empowerment, and (b) how increased empowerment affects other areas of women's lives. Methods With a total of 63 interviewees (i.e., 40 participating women, 7 trainers, 3 project coordinators, and 13 stakeholders), we conducted 53 semi-structured qualitative interviews in five BIG communities between 2007 and 2011. Some interviews were conducted with two people simultaneously. The interview guide contained questions on various dimensions of empowerment (e.g., project engagement, increased self-efficacy, and developed competencies). Framework analysis was used for the analytical process. Results BIG contributed to women's empowerment in various ways, including increased self-efficacy, social network promotion, competency development, and increased motivation to change physical activity behavior. Women who took on added tasks and became more involved in project planning also strengthened their organizational empowerment. Furthermore, increased empowerment had a positive influence on the women's quality of life, family, and professional lives. Conclusion The novel findings helped in understanding the effects of a complex empowerment-based approach that promoted physical activity among women in difficult life situations. Future research should focus on the long-term effects of these programs and their transferability to other sites. Further effort is necessary in the area of public health policy.
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Affiliation(s)
- Alexandra Sauter
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
| | - Annika Herbert-Maul
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Ansgar Thiel
- Institute of Sports Science, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Heiko Ziemainz
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Stephanie Linder
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Anne Herrmann-Johns
- Department of Epidemiology and Preventive Medicine, Medical Sociology, University of Regensburg, Regensburg, Germany
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Salmi LR, Noël L, Saillour-Glénisson F. [Decision-making process and evaluation of public health interventions]. Rev Epidemiol Sante Publique 2022; 71:101384. [PMID: 35831220 PMCID: PMC9271323 DOI: 10.1016/j.respe.2022.06.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/07/2022] [Accepted: 06/14/2022] [Indexed: 11/28/2022] Open
Abstract
Objectif Nous proposons un cadre méthodologique destiné aux experts impliqués dans l'appui à la décision concernant les interventions de santé publique. Méthodes Le cadre méthodologique comprend quatre éléments : 1) une série de neuf questions, formulées en termes non techniques, pertinentes pour juger de l'utilité d'une intervention, considérée à un moment donné dans un contexte donné ; 2) une traduction de ces questions en concepts liés à l'évaluation des interventions (définition de l'intervention, de sa cible et de son objectif, efficacités potentielle et réelle, sécurité, efficience et équité) ; 3) une organisation logique des informations nécessaires pour répondre aux questions ; 4) un algorithme permettant de traduire les informations disponibles en recommandations sur l'utilité réelle de l'intervention dans le contexte où les questions ont été posées. Résultats Chaque étape est illustrée par des questions posées sur des interventions de sécurité routière, le dépistage, la transfusion sanguine et des mesures proposées pendant la pandémie de COVID-19. Conclusion La décision peut être facilitée si les experts fournissent aux décideurs un résumé formel des forces et faiblesses des connaissances, fondé sur une analyse de toutes les facettes de l'utilité potentielle d'une intervention.
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Affiliation(s)
- L-R Salmi
- Université de Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, F-33000 Bordeaux, France.
| | - L Noël
- Consultant, F-74940 Annecy-Le-Vieux, France
| | - F Saillour-Glénisson
- Université de Bordeaux, ISPED, F-33000 Bordeaux, France; Inserm, ISPED, Centre Inserm U1219-Bordeaux Population Health, F-33000 Bordeaux, France; CHU de Bordeaux, Pôle de Santé Publique, Service d'information médicale, F-33000 Bordeaux, France
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Peralta LR, Yager Z, Prichard I. Practice-based evidence: Perspectives of effective characteristics of Australian group-based physical activity programs for postpartum women. Health Promot J Austr 2022; 33:891-903. [PMID: 34839546 DOI: 10.1002/hpja.561] [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: 08/25/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED Many postpartum women often do not achieve recommendations of at least 150 minutes moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has focused on postpartum women's barriers and challenges to being active, with recent research starting to explore the characteristics of PA programs and women who are active during the postpartum period. Yet, little research has focused on the characteristics of key stakeholders and community organisations that support women to sustain their PA engagement during the postpartum period. METHODS This research generates practice-based evidence to provide essential insights for effective implementation, strategies and actions of community group-based PA programs that recruit and retain postpartum women to ensure future interventions are scalable and sustainable. Ten participants (90% female), ranging in age from 34 to 40 years, were recruited from nine community organisations/businesses. The ten participants engaged in semi-structured interviews for an average length of 31 minutes. RESULTS Inductive thematic analysis revealed four overarching themes (i) effective practitioners have a history of, and passion for women's health and PA; (ii) low-cost, connected approaches attract postpartum women into community group-based PA programs; (iii) inclusive, flexible, varied, and holistic approaches sustain postpartum women's participation; and (iv) utilise connections to overcome barriers to community group-based PA programs. These four themes were informed by twelve sub-themes relating to the background of stakeholders and practitioners and the approaches that they use to attract and sustain postpartum women in community group-based PA programs. CONCLUSIONS Practice-based findings should inform future practices and the development of future real-world group-based PA interventions for postpartum women. SO WHAT?: Specifically, interventions will need to be designed and implemented by practitioners who have a history of, and passion for women's health and PA, be low-cost, connected approaches, that are inclusive, flexible, varied, and holistic that prioritise physical, emotional, and social wellbeing.
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Affiliation(s)
- Louisa R Peralta
- School of Education and Social Work, Faculty of Education and Social Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Zali Yager
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Ivanka Prichard
- Health & Exercise Sciences, College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Elsey H, Al Azdi Z, Regmi S, Baral S, Fatima R, Fieroze F, Huque R, Karki J, Khan DM, Khan A, Khan Z, Li J, Noor M, Arjyal A, Shrestha P, Ullah S, Siddiqi K. Scaling up tobacco cessation within TB programmes: findings from a multi-country, mixed-methods implementation study. Health Res Policy Syst 2022; 20:43. [PMID: 35436896 PMCID: PMC9014631 DOI: 10.1186/s12961-022-00842-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/22/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Brief behavioural support can effectively help tuberculosis (TB) patients quit smoking and improve their outcomes. In collaboration with TB programmes in Bangladesh, Nepal and Pakistan, we evaluated the implementation and scale-up of cessation support using four strategies: (1) brief tobacco cessation intervention, (2) integration of tobacco cessation within routine training, (3) inclusion of tobacco indicators in routine records and (4) embedding research within TB programmes. METHODS We used mixed methods of observation, interviews, questionnaires and routine data. We aimed to understand the extent and facilitators of vertical scale-up (institutionalization) within 59 health facility learning sites in Pakistan, 18 in Nepal and 15 in Bangladesh, and horizontal scale-up (increased coverage beyond learning sites). We observed training and surveyed all 169 TB health workers who were trained, in order to measure changes in their confidence in delivering cessation support. Routine TB data from the learning sites were analysed to assess intervention delivery and use of TB forms revised to report smoking status and cessation support provided. A purposive sample of TB health workers, managers and policy-makers were interviewed (Bangladesh n = 12; Nepal n = 13; Pakistan n = 19). Costs of scale-up were estimated using activity-based cost analysis. RESULTS Routine data indicated that health workers in learning sites asked all TB patients about tobacco use and offered them cessation support. Qualitative data showed use of intervention materials, often with adaptation and partial implementation in busy clinics. Short (1-2 hours) training integrated within existing programmes increased mean confidence in delivering cessation support by 17% (95% CI: 14-20%). A focus on health system changes (reporting, training, supervision) facilitated vertical scale-up. Dissemination of materials beyond learning sites and changes to national reporting forms and training indicated a degree of horizontal scale-up. Embedding research within TB health systems was crucial for horizontal scale-up and required the dynamic use of tactics including alliance-building, engagement in the wider policy process, use of insider researchers and a deep understanding of health system actors and processes. CONCLUSIONS System-level changes within TB programmes may facilitate routine delivery of cessation support to TB patients. These strategies are inexpensive, and with concerted efforts from TB programmes and donors, tobacco cessation can be institutionalized at scale.
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Affiliation(s)
- Helen Elsey
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK.
| | - Zunayed Al Azdi
- ARK Foundation, Suite C-3, C-4, House # 06, Road # 109, Gulshan-2, Bangladesh
| | | | - Sushil Baral
- HERDi, Prasuti Griha Marg, Kathmandu, 44600, Nepal
| | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
| | - Fariza Fieroze
- ARK Foundation, Suite C-3, C-4, House # 06, Road # 109, Gulshan-2, Bangladesh
| | - Rumana Huque
- ARK Foundation, Suite C-3, C-4, House # 06, Road # 109, Gulshan-2, Bangladesh
| | - Jiban Karki
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK
| | | | - Amina Khan
- The Initiative, Orange Grove Farm, Main Korung Road, Malpur, Bani Gala, Islamabad, Pakistan
| | - Zohaib Khan
- Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, 25100, Khyber Pakhtunkhwa, Pakistan
| | - Jinshuo Li
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK
| | - Maryam Noor
- The Initiative, Orange Grove Farm, Main Korung Road, Malpur, Bani Gala, Islamabad, Pakistan
| | | | | | - Safat Ullah
- Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, 25100, Khyber Pakhtunkhwa, Pakistan
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, Y010 5DD, UK
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Koorts H, Maple JL, Eakin E, Lawrence M, Salmon J. Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia. Front Public Health 2022; 10:771235. [PMID: 35419340 PMCID: PMC8995799 DOI: 10.3389/fpubh.2022.771235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023] Open
Abstract
Background Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder. Methods A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report “20 Questions for Developing a Scaling up Case Study”, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically. Results Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the “Environment”, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to “Scale up strategy” (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions. Conclusion Attributes of the “Environment” and “Scale up strategy” consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jaimie-Lee Maple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Elizabeth Eakin
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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Sutherland RL, Jackson JK, Lane C, McCrabb S, Nathan NK, Yoong SL, Lum M, Byaruhanga J, McLaughlin M, Brown A, Milat AJ, Bauman AE, Wolfenden L. A systematic review of adaptations and effectiveness of scaled-up nutrition interventions. Nutr Rev 2022; 80:962-979. [PMID: 34919715 PMCID: PMC8907487 DOI: 10.1093/nutrit/nuab096] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Public health nutrition interventions shown to be effective under optimal research conditions need to be scaled up and implemented in real-world settings. OBJECTIVES The primary aim for this review was to assess the effectiveness of scaled-up public health nutrition interventions with proven efficacy, as examined in a randomized controlled trial. Secondary objectives were to: 1) determine if the effect size of scaled-up interventions were comparable to the prescale effect, and; 2) identify any adaptations made during the scale-up process. DATA SOURCES Six electronic databases were searched and field experts contacted. STUDY SELECTION An intervention was considered scaled up if it was delivered on a larger scale than a preceding randomized controlled trial ("prescale") in which a significant intervention effect (P ≤ 0.05) was reported on a measure of nutrition. DATA EXTRACTION Two reviewers independently performed screening and data extraction. Effect size differences between prescale and scaled-up interventions were quantified. Adaptations to scale-up studies were coded according to the Adaptome model. RESULTS Ten scaled-up nutrition interventions were identified. The effect size difference between prescale trials and scaled-up studies ranged from -32.2% to 222% (median, 50%). All studies made adaptations between prescale to scaled-up interventions. CONCLUSION The effects of nutrition interventions implemented at scale typically were half that achieved in prior efficacy trials. Identifying effective scale-up strategies and methods to support retainment of the original prescale effect size is urgently needed to inform public health policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no.CRD42020149267.
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Affiliation(s)
- Rachel L Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Jacklyn K Jackson
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Nicole K Nathan
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Melanie Lum
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Matthew McLaughlin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Alison Brown
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Andrew J Milat
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian E Bauman
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health Unit, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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Kavanagh SA, Hawe P, Shiell A, Mallman M, Garvey K. Soft infrastructure: the critical community-level resources reportedly needed for program success. BMC Public Health 2022; 22:420. [PMID: 35236315 PMCID: PMC8889705 DOI: 10.1186/s12889-022-12788-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background The mechanisms typically used to fund health promotion in communities, either as part of an effort to scale-up programs or to support the design of local activities, often pay insufficient attention to the foundational means of enhancing well-being. Only recently have researchers begun to critically ‘unpack’ how funding processes connect with and activate local community capacities. Methods We conducted a thematic analysis of 33 interviews with policy and program administrators in public health and local community workers and volunteers. We invited them to expound on their understandings of resources - specifically, what needs to be in place to make funded programs successful and/or what do communities draw on to make funded programs effective. Results Policy and program administrators reflected mostly on the importance of traditional resources, such as adequate funding and staffing. Community-based participants often went further to describe psychological and sociological resources – the “soft infrastructure” which included trust and hope. Both groups emphasised the importance of building networks and relationships at multiple levels. Community workers also provided examples of how resources grow and improve in value in combination with other processes or through pathways of resource use or resource distribution. So, resources like information/knowledge are made more valuable when relayed locally. Physical amenities (e.g., meeting spaces, kitchens) have an instrumental role, but also act powerfully as a symbolic resource for identity. Participants reported that funding processes can damage the resources required for community health improvement. Funding instability undermines capacity. The ongoing threat of funding removal was described by one administrator as community “bullying”. Conclusions Processes of health promotion funding, and even standard processes of program scale-up and readiness assessment, risk underestimating the range of resources that are fundamental for community health improvement, particularly among disadvantaged communities. Funders should design ways to resource communities so that there is constant attention to and coaching of critically important diverse processes of resource growth, independent of program-specific funds. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12788-8.
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Affiliation(s)
- Shane A Kavanagh
- School of Health & Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia. .,The Australian Prevention Partnership Centre, 1240, Haymarket, New South Wales, Australia.
| | - Penelope Hawe
- Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, Australia
| | - Alan Shiell
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Mark Mallman
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Kate Garvey
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Department of Health, Hobart, Tasmania, Australia
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Larouche A, Bilodeau A, Laurin I, Potvin L. Health promotion innovations scale up: combining insights from framing and actor-network to foster reflexivity. Health Promot Int 2022; 37:daab026. [PMID: 33724367 DOI: 10.1093/heapro/daab026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
There are numerous hurdles down the road for successfully scaling up health promotion innovations into formal programmes. The challenges of the scaling-up process have mainly been conceived in terms of available resources and technical or management problems. However, aiming for greater impact and sustainability involves addressing new contexts and often adding actors whose perspectives may challenge established orientations. The social dimension of the scaling-up process is thus critical. Building on existing conceptualizations of interventions as dynamic networks and of evolving framing of health issues, this paper elaborates a social view of scaling up that accounts for the transformations of innovations, using framing analysis and the notion of 'expanding scaling-up networks'. First, we discuss interventions as dynamic networks. Second, we conceptualize scaling-up processes as networks in expansion within which social learning and change occur. Third, we propose combining a 'representational approach' to frame analysis and an 'interactional approach' that illustrates framing processes related to the micro-practices of leading public health actors within expanding networks. Using an example concerning equity in early childhood development, we show that this latter approach allows documenting how frames evolve in the process. Considering the process in continuity with existing conceptualizations of interventions as actor-networks and transformation of meanings enriches our conceptualization of scaling up, improves our capacity to anticipate its outcomes, and promotes reflexivity about health promotion goals and means.
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Affiliation(s)
- Annie Larouche
- Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS), Université de Montréal, Qc, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Qc, Canada
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Qc, Canada
- Direction régionale de santé publique, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Qc, Canada
| | - Angèle Bilodeau
- Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS), Université de Montréal, Qc, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Qc, Canada
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Qc, Canada
- Centre de recherche Léa-Roback, Montréal, Qc, Canada
| | - Isabelle Laurin
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Qc, Canada
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Qc, Canada
- Centre de recherche Léa-Roback, Montréal, Qc, Canada
- Direction régionale de santé publique, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Qc, Canada
| | - Louise Potvin
- Chaire de recherche du Canada Approches communautaires et inégalités de santé (CACIS), Université de Montréal, Qc, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Qc, Canada
- Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Qc, Canada
- Centre de recherche Léa-Roback, Montréal, Qc, Canada
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Calnan S, Lee K, McHugh S. Assessing the scalability of an integrated falls prevention service for community-dwelling older people: a mixed methods study. BMC Geriatr 2022; 22:17. [PMID: 34979957 PMCID: PMC8721469 DOI: 10.1186/s12877-021-02717-6] [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: 07/22/2021] [Accepted: 12/13/2021] [Indexed: 11/11/2022] Open
Abstract
Background There is growing acknowledgement of the need for a phased approach to scaling up health interventions, beginning with an assessment of ‘scalability’, that is, the capacity of an individual intervention to be scaled up. This study aims to assess the scalability of a multi-component integrated falls prevention service for community-dwelling older people and to examine the applicability of the Intervention Scalability Assessment Tool (ISAT). The ISAT consists of 10 domains for consideration when determining the scalability of an intervention, and each domain comprises a series of questions aimed at examining readiness for scale-up. Methods Multiple methods were used sequentially as recommended by the ISAT: a review of policy documents, results from a service evaluation and falls-related literature; one-to-one interviews (n = 11) with key stakeholders involved in management and oversight of the service; and a follow-up online questionnaire (n = 10) with stakeholders to rate scalability and provide further feedback on reasons for their scores. Results Three of the ISAT domains were rated highly by the participants. Analysis of the qualitative feedback and documents indicated that the issue of falls prevention among older people was of sufficient priority to warrant scale-up of the service and that the service aligned with national health policy priorities. Some participants also noted that benefits of the service could potentially outweigh costs through reduced hospital admissions and serious injuries such as hip fracture. The remaining domains received a moderate score from participants, however, indicating considerable barriers to scale-up. In the qualitative feedback, barriers identified included the perceived need for more healthcare staff to deliver components of the service, for additional infrastructure such as adequate room space, and for an integrated electronic patient management system linking primary and secondary care and to prevent duplication of services. Conclusions Plans to scale up the service are currently under review given the practical barriers that need to be addressed. The ISAT provides a systematic and structured framework for examining the scalability of this multi-component falls prevention intervention, although the iterative nature of the process and detailed and technical nature of its questions require considerable time and knowledge of the service to complete. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02717-6.
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Affiliation(s)
- Susan Calnan
- School of Public Health, University College Cork, Western Road, Cork, Ireland.
| | - Karen Lee
- School of Public Health, The University of Sydney, NSW, Sydney, Australia
| | - Sheena McHugh
- School of Public Health, University College Cork, Western Road, Cork, Ireland
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Bélanger M, Carpenter JG, Sabiston CM, Vanderloo LM, Trono C, Gallant F, Thibault V, Doré I, O'Loughlin J. Identifying priorities for sport and physical activity research in Canada: an iterative priority-setting study. CMAJ Open 2022; 10:E269-E277. [PMID: 35318251 PMCID: PMC8946649 DOI: 10.9778/cmajo.20210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a need for better alignment between research on sport and physical activity and the needs of those who are in a position to implement the findings. To facilitate advancement and alignment, we identified the top research priorities of sport and physical activity knowledge users from various sectors. METHODS For this priority-setting study, we used an iterative process of data collection and analysis. Sport and physical activity knowledge users from multiple sectors participated in a workshop (September 2019), which included small working group exercises followed by large-group syntheses leading to the identification of issues that required better understanding. We then sent an online questionnaire to participants for content validation and interim prioritization, to reduce the number of priorities (December 2019 to January 2020). A new questionnaire containing a shortened list of research priorities was sent to an expanded group of respondents to further streamline the list of priorities (January-March 2020). RESULTS The 24 workshop participants identified 68 issues, of which 21 were retained by the 18 participants in the interim priority-setting questionnaire. The final prioritization questionnaire was completed by 33 stakeholder groups; this step produced a final list of 8 top research priorities. The final priorities identified for sport and physical activity research related to financial support, suboptimal promotion, dropout, best interventions, participation among Indigenous populations, volunteer engagement, safe and inclusive experiences, and knowledge exchange. INTERPRETATION The 8 priorities identified in this study provide guidance to Canadian sport and physical activity researchers. Research efforts on these priorities will reflect pressing issues as identified by representatives of all sport and physical activity sectors.
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Affiliation(s)
- Mathieu Bélanger
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que.
| | - Julie Goguen Carpenter
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Catherine M Sabiston
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Leigh M Vanderloo
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Carolyn Trono
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - François Gallant
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Véronique Thibault
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Isabelle Doré
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
| | - Jennifer O'Loughlin
- Department of Family and Emergency Medicine (Bélanger) and Faculty of Medicine and Health Sciences (Gallant, Thibault), Université de Sherbrooke, Sherbrooke, Que.; Centre de formation médicale du Nouveau-Brunswick (Bélanger, Goguen Carpenter, Gallant, Thibault), Moncton, NB; Faculty of Kinesiology and Physical Education (Sabiston), University of Toronto; ParticipACTION (Vanderloo), Toronto, Ont.; Sport for Life (Trono), Victoria, BC; School of Kinesiology and Physical Activity Sciences (Doré), Faculty of Medicine, and Department of Social and Preventive Medicine (Doré, O'Loughlin), École de santé publique, Université de Montréal, Montréal, Que
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Patterson JA, Cashmore A, Ioannides S, Milat AJ, Nippita TA, Morris JM, Torvaldsen S. Benefits of not smoking during pregnancy for non-Aboriginal women and their babies in New South Wales, Australia: a record linkage study. Int J Popul Data Sci 2021; 6:1699. [PMID: 34970635 PMCID: PMC8678976 DOI: 10.23889/ijpds.v6i3.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Smoking rates among pregnant women in New South Wales (NSW) have plateaued at 8-9%. To inform relevant smoking reduction efforts, we aimed to quantify the benefits of not smoking during pregnancy for non-Aboriginal NSW mothers and their babies. The benefits of not smoking during pregnancy for NSW Aboriginal mothers have previously been described. These data are important inputs in modelling health and economic impacts of smoking cessation interventions. METHODS This population-based cohort study used linked-data from routinely collected data sets. Not smoking during pregnancy was the exposure of interest among all NSW non-Aboriginal women who became mothers of singleton babies in 2012-2016. Unadjusted and adjusted relative risks (aRR) were used to examine associations between not smoking during pregnancy and adverse outcomes including severe morbidity, inter-hospital transfer, perinatal death, preterm birth and small-for-gestational age. Population attributable fractions (PAFs) were calculated to quantify adverse perinatal outcomes avoided in the population if all mothers were non-smokers. RESULTS Compared with babies born to mothers who smoked during pregnancy, babies born to non-smoking mothers had a lower risk of all adverse perinatal outcomes including perinatal death (aRR = 0.68, 95%CI 0.61-0.76), preterm birth (aRR = 0.58, 95%CI 0.56-0.61) and small-for-gestational age (aRR = 0.48, 95%CI 0.47-0.50). PAFs(%) were 3.9% for perinatal death, 5.6% for preterm birth and 7.3% for small-for-gestational-age. Compared with women who smoked during pregnancy (n = 36,518), those who did not smoke (n = 413,072) had a lower risk of suffering severe maternal morbidity (aRR = 0.87, 95%CI 0.81-0.93) and being transferred to another hospital (aRR = 0.92, 95%CI 0.86-0.99). CONCLUSIONS Mothers who reported not smoking during pregnancy had a small reduction in their risk of morbidity and of being transferred to another hospital whilst their babies had substantially reduced risks of all adverse perinatal outcomes. Results have implications for clinician training, clinical care standards, and performance management.
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Affiliation(s)
- Jillian A. Patterson
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, 2065, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, New South Wales, Australia
| | - Aaron Cashmore
- NSW Ministry of Health, Centre for Epidemiology and Evidence, St Leonards, 2065, New South Wales, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, 2006, New South Wales, Australia
| | - Sally Ioannides
- NSW Ministry of Health, Centre for Epidemiology and Evidence, St Leonards, 2065, New South Wales, Australia
- School of Population Health, UNSW, Kensington, 2052, New South Wales, Australia
| | - Andrew J. Milat
- NSW Ministry of Health, Centre for Epidemiology and Evidence, St Leonards, 2065, New South Wales, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, 2006, New South Wales, Australia
| | - Tanya A. Nippita
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, 2065, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, New South Wales, Australia
| | - Jonathan M. Morris
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, 2065, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, New South Wales, Australia
| | - Siranda Torvaldsen
- The University of Sydney Northern Clinical School, Women and Babies Research, St Leonards, 2065, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, New South Wales, Australia
- School of Population Health, UNSW, Kensington, 2052, New South Wales, Australia
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Spooner C, Lewis V, Scott C, Dahrouge S, Haggerty J, Russell G, Levesque JF, Dionne E, Stocks N, Harris MF. Improving access to primary health care: a cross-case comparison based on an a priori program theory. Int J Equity Health 2021; 20:223. [PMID: 34635116 PMCID: PMC8504080 DOI: 10.1186/s12939-021-01508-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Inequitable access to primary health care (PHC) remains a problem for most western countries. Failure to scale up effective interventions has been due, in part, to a failure to share the logic and essential elements of successful programs. The aim of this paper is to describe what we learned about improving access to PHC for vulnerable groups across multiple sites through use of a common theory-based program logic model and a common evaluation approach. This was the IMPACT initiative. Methods IMPACT’s evaluation used a mixed methods design with longitudinal (pre and post) analysis of six interventions. The analysis for this paper included four of the six sites that met study criteria. These sites were located in Canada (Alberta, Quebec and Ontario) and Australia (New South Wales). Using the overarching logic model, unexpected findings were reviewed, and alternative explanations were considered to understand how the mechanisms of each intervention may have contributed to results. Results Each site addressed their local access problem with different strategies and from different starting points. All sites observed changes in patient abilities to access PHC and provider access capabilities. The combination of intended and observed consequences for consumers and providers was different at each site, but all sites achieved change in both consumer ability and provider capability, even in interventions where there was no activity targeting provider behaviors. Discussion The model helped to identify, explore and synthesize intended and unintended consequences of four interventions that appeared to have more differences than similarities. Similar outcomes for different interventions and multiple impacts of each intervention on abilities were observed, implying complex causal pathways. Conclusions All the interventions were a low-cost incremental attempt to address unmet health care needs of vulnerable populations. Change is possible; sustaining change may be more challenging. Access to PHC requires attention to both patient abilities and provider characteristics. The logic model proved to be a valuable heuristic tool for defining the objectives of the interventions, evaluating their impacts, and learning from the comparison of ‘cases’.
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Affiliation(s)
- Catherine Spooner
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
| | | | | | - Simone Dahrouge
- C.T. Lamont Primary Health Care Research Centre, Elisabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Grant Russell
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | | | - Emilie Dionne
- St. Mary's Research Centre, McGill University, Montreal, Quebec, Canada
| | - Nigel Stocks
- Department of General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Finnegan A, Biru B, Taylor A, Rajan S, Udayakumar K, Baumgartner JN. Improving global maternal and newborn survival via innovation: Stakeholder perspectives on the Saving Lives at Birth Grand Challenge. PLoS One 2021; 16:e0254589. [PMID: 34260640 PMCID: PMC8279342 DOI: 10.1371/journal.pone.0254589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 06/30/2021] [Indexed: 11/19/2022] Open
Abstract
The Saving Lives at Birth (SL@B) funding partners joined in 2011 to source, support, and scale maternal and newborn health (MNH) innovations to improve maternal and newborn survival by focusing on the 24 hours around the time of birth. A multi-methods, retrospective portfolio evaluation was conducted to determine SL@B's impact. Forty semi-structured, key informant interviews (KIIs) were conducted with experts in global MNH based in low- and middle-income and in high-income countries to assess the SL@B program. KIIs were conducted with global MNH technical experts, innovators, government officials in low- and middle-income countries, donors, private investors, and implementing partners to include the full spectrum of voices involved in identifying and scaling innovations. Data were analyzed using thematic analysis. Stakeholders believe the SL@B program has been successful in changing the way maternal and newborn health programs are delivered with a focus on doing things differently through innovation. The open approach to sourcing innovation was seen as positive to the extent that it brought more interdisciplinary stakeholders to think about the problem of maternal and newborn survival. However, a demand-driven approach that aims to source innovations that address MNH priority needs and takes into account the needs of end users (e.g. individuals and governments) was suggested as a strategy for ensuring that more innovations go to scale.
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Affiliation(s)
- Amy Finnegan
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Blen Biru
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Andrea Taylor
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Sowmya Rajan
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Krishna Udayakumar
- Duke Global Health Innovation Center, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Joy Noel Baumgartner
- Evidence Lab, Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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Mwaikambo L, Brittingham S, Ohkubo S, Salem R, Sama DJ, Sow F, Mathur D, Anieto NN. Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia. Global Health 2021; 17:75. [PMID: 34217354 PMCID: PMC8254949 DOI: 10.1186/s12992-021-00717-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.
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Affiliation(s)
- Lisa Mwaikambo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | | | - Saori Ohkubo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Ruwaida Salem
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Denis Joel Sama
- The Challenge Initiative, East Africa Hub, Jhpiego, Kampala, Uganda
| | - Fatimata Sow
- The Challenge Initiative, Francophone West Africa Hub, IntraHealth International, Dakar, Senegal
| | - Deepti Mathur
- The Challenge Initiative for Healthy Cities, India Hub, Population Services International, Delhi, India
| | - Nneoma Nonyelum Anieto
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
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Scaling up Action Schools! BC: How Does Voltage Drop at Scale Affect Student Level Outcomes? A Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105182. [PMID: 34068235 PMCID: PMC8153156 DOI: 10.3390/ijerph18105182] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023]
Abstract
Action Schools! BC (AS! BC) was scaled-up from an efficacy trial to province-wide delivery across 11 years (2004-2015). In this study we: (1) describe strategies that supported implementation and scale-up; (2) evaluate implementation (teachers' physical activity (PA) delivery) and student's PA and cardiorespiratory fitness (CRF) within a cluster randomized controlled trial during years 2 and 3 of scale-up; and (3) assess relationships between teacher-level implementation and student-level outcomes. We classified implementation strategies as process, capacity-building or scale-up strategies. Elementary schools (n = 30) were randomized to intervention (INT; 16 schools; 747 students) or usual practice (UP; 14 schools; 782 students). We measured teachers' PA delivery (n = 179) using weekly logs; students' PA by questionnaire (n = 30 schools) and accelerometry (n = 9 schools); and students' CRF by 20-m shuttle run (n = 25 schools). INT teachers delivered more PA than UP teachers in year 1 (+33.8 min/week, 95% CI 12.7, 54.9) but not year 2 (+18.8 min/week, 95% CI -0.8, 38.3). Unadjusted change in CRF was 36% and 27% higher in INT girls and boys, respectively, compared with their UP peers (year 1; effect size 0.28-0.48). Total PA delivered was associated with change in children's self-reported MVPA (year 1; r = 0.17, p = 0.02). Despite the 'voltage drop', scaling-up school-based PA models is feasible and may enhance children's health. Stakeholders must conceive of new ways to effectively sustain scaled-up health promoting interventions if we are to improve the health of students at a population level. Clinical Trials registration: NCT01412203.
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Abu-Omar K, Ziemainz H, Loss J, Laxy M, Holle R, Thiel A, Herbert-Maul A, Linder S, Till M, Sauter A. The Long-Term Public Health Impact of a Community-Based Participatory Research Project for Health Promotion Among Socially Disadvantaged Women-A Case Study Protocol. Front Public Health 2021; 9:628630. [PMID: 33912528 PMCID: PMC8075296 DOI: 10.3389/fpubh.2021.628630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Community-based participatory research (CBPR) is considered to be of high potential for health promotion among socially disadvantaged groups. However, the long-term implementation and transfer of these approaches remain challenging, and the public health impact they achieve is difficult to study. This also pertains to the potential health effects and cost-effectiveness of CBPR. This study protocol describes the follow-up case study (NU-BIG) after 15 years of the BIG project (“movement as investment in health”), a project to promote physical activity among socially disadvantaged women. Through a participatory approach, BIG empowers the addressed women to plan and implement low-threshold physical activity offers. Since the project started in 2005, it was transferred to 17 communities in Germany. Materials and Analysis: NU-BIG intends to examine the long-term effects, including economic aspects, of the BIG project on individual and structural levels at all project sites, as well as its long-term implementation and transfer. NU-BIG is a cross-sectional and longitudinal study using a mixed method approach. For the longitudinal section, we re-analyze existing data from former BIG evaluations. For cross-sectional data collection, we use questionnaires and conduct qualitative interviews and focus groups. Women who take part in BIG program offers are part of the research team and will use the photo-voice approach to report on the effects of BIG. The study population consists of about 800 women who participate in BIG project offers and 50 persons involved in the implementation of the BIG project at local sites. Discussion: The expected results from NU-BIG are highly relevant for studying the long-term public health impact of CBPR. In particular, this project intends to answer questions on how the transfer of such projects can succeed and which factors determine if a CBPR project can be sustained at the community level. Eventually, these results can contribute to the further development of participatory approaches to provide effective health promotion among socially disadvantaged groups. Conclusion: Although CBPR is seen of having the potential to reduce health disparities, there is still a lack of research on its long-term effects and public health impact. NU-BIG aims at generating knowledge about the economic effects, reach, efficacy, adoption, implementation, and maintenance of a CBPR project. The expected results could be of high interest for BIG and other CBPR-projects.
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Affiliation(s)
- Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Heiko Ziemainz
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Julika Loss
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michael Laxy
- Department of Sport and Health Sciences, Entrepreneurial University Munich, Munich, Germany
| | - Rolf Holle
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Ansgar Thiel
- Institute of Sports Science, Eberhard-Karls-Universität Tübingen, Tübingen, Germany
| | - Annika Herbert-Maul
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Linder
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Maike Till
- Department of Sport Science and Sport, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandra Sauter
- Medical Sociology, Department for Epidemiology and Preventive Medicine, University Regensburg, Regensburg, Germany
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Nathan N, McCarthy N, Hope K, Sutherland R, Lecathelinais C, Hall A, Lane C, Trost S, Yoong SL, Wolfenden L. The impact of school uniforms on primary school student's physical activity at school: outcomes of a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2021; 18:17. [PMID: 33485340 PMCID: PMC7825216 DOI: 10.1186/s12966-021-01084-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Many school-based physical activity (PA) interventions are complex and have modest effects when delivered in real world contexts. A commonly reported barrier to students’ PA, particularly among girls, are uniforms that are impractical (e.g. tunic/dress and black leather shoes). Modifying student uniforms may represent a simple intervention to enhance student PA. The primary aim of this trial was to assess the impact of a PA enabling uniform intervention (shorts, polo shirt and sports shoes) on girls’ moderate-to-vigorous physical activity (MVPA) and total PA i.e. counts per minute (cpm). Methods A cluster randomized controlled trial was undertaken in 42 primary schools in New South Wales, Australia. Schools were randomized on one school day to the intervention group, where students wore a PA enabling uniform (their sports uniform) or a control group, where students wore their usual traditional uniform. Student PA was measured using wrist-worn Actigraph GT3X and GT9X accelerometers. Linear mixed models controlling for student characteristics were used to examine the effects of the intervention.. Results Of the 3351 eligible students, 2315 (69.1%) had parental consent and 2180 of these consenting students participated (94.2%) of which 1847 (84.7%) were included in the analysis. For the primary aim the study found no significant differences between girls at schools allocated to the intervention relative to the control on change in MVPA (0.76 min, 95% CI − 0.47 to 1.99, p = 0.22) or cpm (36.99, 95% CI − 13.88 to 87.86, p = 0.15). Exploratory analysis revealed small effects for a number of findings, including significant reduction in sedentary activity (− 1.77, 95% CI − 3.40 to − 0.14, p = 0.035) among all students at schools allocated to the intervention, and non-significant improvements in girls’ light intensity PA (1.47 min, 95% CI − 0.06 to 3.00, p = 0.059) and sedentary activity (− 2.23 min; 95% CI − 4.49 to 0.02, p = 0.052). Conclusion The findings suggests that the intervention may yield small improvements in some measure of PA and require substantiation in a larger RCT with longer-term follow-up. The inclusion of additional intervention components may be required to achieve more meaningful effects. Trial registration The trial was prospectively registered with Australian New Zealand Clinical Trials Register ACTRN12617001266358 1st September 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01084-0.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Nicole McCarthy
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Kirsty Hope
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation at Queensland Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle; Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Lane C, McCrabb S, Nathan N, Naylor PJ, Bauman A, Milat A, Lum M, Sutherland R, Byaruhanga J, Wolfenden L. How effective are physical activity interventions when they are scaled-up: a systematic review. Int J Behav Nutr Phys Act 2021; 18:16. [PMID: 33482837 PMCID: PMC7821550 DOI: 10.1186/s12966-021-01080-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background The ‘scale-up’ of effective physical activity interventions is required if they are to yield improvements in population health. The purpose of this study was to systematically review the effectiveness of community-based physical activity interventions that have been scaled-up. We also sought to explore differences in the effect size of these interventions compared with prior evaluations of their efficacy in more controlled contexts, and describe adaptations that were made to interventions as part of the scale-up process. Methods We performed a search of empirical research using six electronic databases, hand searched reference lists and contacted field experts. An intervention was considered ‘scaled-up’ if it had been intentionally delivered on a larger scale (to a greater number of participants, new populations, and/or by means of different delivery systems) than a preceding randomised control trial (‘pre-scale’) in which a significant intervention effect (p < 0.05) was reported on any measure of physical activity. Effect size differences between pre-scale and scaled up interventions were quantified ([the effect size reported in the scaled-up study / the effect size reported in the pre-scale-up efficacy trial] × 100) to explore any scale-up ‘penalties’ in intervention effects. Results We identified 10 eligible studies. Six scaled-up interventions appeared to achieve significant improvement on at least one measure of physical activity. Six studies included measures of physical activity that were common between pre-scale and scaled-up trials enabling the calculation of an effect size difference (and potential scale-up penalty). Differences in effect size ranged from 132 to 25% (median = 58.8%), suggesting that most scaled-up interventions typically achieve less than 60% of their pre-scale effect size. A variety of adaptations were made for scale-up – the most common being mode of delivery. Conclusion The majority of interventions remained effective when delivered at-scale however their effects were markedly lower than reported in pre-scale trials. Adaptations of interventions were common and may have impacted on the effectiveness of interventions delivered at scale. These outcomes provide valuable insight for researchers and public health practitioners interested in the design and scale-up of physical activity interventions, and contribute to the growing evidence base for delivering health promotion interventions at-scale. Trial registration PROSPERO CRD42020144842. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01080-4.
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Affiliation(s)
- Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Adrian Bauman
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Lum
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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41
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Bourke M, Hilland TA, Craike M. Factors associated with the institutionalization of a physical activity program in Australian elementary schools. Transl Behav Med 2020; 10:1559-1565. [PMID: 31344235 DOI: 10.1093/tbm/ibz126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The health benefits of classroom-based physical activity programs may only be sustained if programs are continually implemented over time. Despite the importance of instituting physical activity programs to ensure their continued implementation, little is known about factors associated with institutionalization of programs at a school level. The purpose of this study is to examine how school context, principal characteristics, and program attributes are associated with the institutionalization of Bluearth Foundation's Active Schools program in Australian elementary schools. Current principals from schools who participated in the Active Schools program between 2015 and 2017 reported the level of institutionalization of the program, school context, principal characteristics, and perceived attributes of the program. Univariate associations were calculated using Pearson's correlation coefficient, independent sample t-tests and one-way ANOVA. Linear regression using backward deletion was used to calculate significant or marginally significant (p < .1) multivariate associations. Thirty of the 211 eligible principals participated in the study. School capacity (r = .617, p < .001); perceived student behavioral (r = .577, p < .001), health (r = .499, p < .001), and enjoyment benefits (r = .529, p < .001), relative advantage (r = .417, p = .022), observability (r = .385, p = .036), and having the program delivered by a Bluearth coach at the time of the study (η 2 = .426, p < .001) all had a significant positive univariate association with institutionalization. School capacity (β = 1.802, p = .001), observability (β = 0.902, p = .061), and having the program delivered by a Bluearth coach at the time of the study (β = 2.580, p = .003) remained significant in the final multivariate model. Results suggest that schools that have someone who can provide support implementing a program are more likely to institute the program into policies and practices. It is also important that school administrators have the tools to evaluate the benefits of physical activity programs and to perceive them as being beneficial for their students. However, schools may struggle to institutionalize physical activity programs after formal program delivery has concluded.
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Affiliation(s)
- Matthew Bourke
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Toni A Hilland
- School of Education, College of Design and Social Context, RMIT, Melbourne, Victoria, Australia
| | - Melinda Craike
- Australian Health Policy Collaboration, Victoria University, Melbourne, Victoria, Australia
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Kennedy SG, Leahy AA, Smith JJ, Eather N, Hillman CH, Morgan PJ, Plotnikoff RC, Boyer J, Lubans DR. Process Evaluation of a School-Based High-Intensity Interval Training Program for Older Adolescents: The Burn 2 Learn Cluster Randomised Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E299. [PMID: 33339356 PMCID: PMC7765884 DOI: 10.3390/children7120299] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/28/2022]
Abstract
Process evaluations can help to optimise the implementation of school-based physical activity interventions. The purpose of this paper is to describe the process evaluation of a school-based high-intensity interval training (HIIT) program for older adolescent students, known as Burn 2 Learn (B2L). B2L was evaluated via a cluster randomised controlled trial in 20 secondary schools (10 intervention, 10 control) in New South Wales, Australia. Teachers (n = 22 (55% female)) from the 10 intervention schools, delivered the program over three phases (Phases 1 and 2, 6 months; Phase 3, 6 months) to older adolescent students (n = 337 (50% female); mean ± standard deviation (SD) age = 16.0 ± 0.4 years). Process evaluation data were collected across the 12-month study period. Teachers delivered 2.0 ± 0.8 and 1.7 ± 0.6 sessions/week in Phases 1 and 2 respectively (mean total 25.9 ± 5.2), but only 0.6 ± 0.7 sessions/week in Phase 3. Observational data showed that session quality was high, however heart rate (HR) data indicated that only half of the students reached the prescribed threshold of ≥85% predicted HRmax during sessions. Over 80% of teachers reported they intended to deliver the B2L program to future student cohorts. Almost 70% of students indicated they intended to participate in HIIT in the future. Teachers considered the program to be adaptable, and both students and teachers were satisfied with the intervention. B2L was implemented with moderate-to-high fidelity in Phases 1 and 2, but low in Phase 3. Our findings add to the relatively scant process evaluation literature focused on the delivery of school-based physical activity programs.
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Affiliation(s)
- Sarah G. Kennedy
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Angus A. Leahy
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Jordan J. Smith
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Narelle Eather
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Charles H. Hillman
- Department of Psychology, Northeastern University, Boston, MA 02115, USA;
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA 02115, USA
| | - Philip J. Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - Ronald C. Plotnikoff
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
| | - James Boyer
- New South Wales Department of Education, School Sport Unit, Sydney, NSW 2000, Australia;
| | - David R. Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, NSW 2308, Australia; (S.G.K.); (A.A.L.); (J.J.S.); (N.E.); (P.J.M.); (R.C.P.)
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van de Vijver P, Schalkwijk F, Numans ME, Slaets JPJ, van Bodegom D. Self-organizing peer coach groups to increase daily physical activity in community dwelling older adults. Prev Med Rep 2020; 20:101181. [PMID: 33088676 PMCID: PMC7567038 DOI: 10.1016/j.pmedr.2020.101181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/22/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Many older adults do not reach the recommended level of physical activity, despite many professional-delivered physical activity interventions. Here we study the implementation of a novel physical activity intervention for older adults that is self-sustainable (no financial support) and self-organizing (participants act as organizers) due to peer coaching. We implemented three groups and evaluated process and effect using participatory observations, questionnaires, six-minute walk tests and body composition measures from October 2016 to September 2018. The intervention was implemented by staff without experience in physical activity interventions. Facilitators were a motivated initiator and a non-professional atmosphere for participants to take ownership. Barriers were the absence of motivated participants to take ownership and insufficient participants to ensure the presence of participants at every exercise session. The groups exercised outside five days a week and were self-organizing after 114, 216 and 263 days. The initial investments were 170€ for sport equipment and 81–187 h. The groups reached 118 members and a retention of 86.4% in two years. The groups continue to exist at the time of writing and are self-sustainable. Quality of life increased 0.4 on a ten-point scale (95%CI 0.1–0.7; p = 0.02) and six-minute walk test results improved with 33 m (95%CI 18–48; p < 0.01) annually. Self-organizing peer coach groups for physical activity are feasible, have positive effects on health and require only a small investment at the start. It is a sustainable and potentially scalable intervention that could be a promising method to help many older adults age healthier.
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Affiliation(s)
- Paul van de Vijver
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333AA Leiden, The Netherlands.,Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Frank Schalkwijk
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333AA Leiden, The Netherlands.,Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
| | - Joris P J Slaets
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333AA Leiden, The Netherlands.,University Center for Geriatric Medicine, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands
| | - David van Bodegom
- Leyden Academy on Vitality and Ageing, Rijnsburgerweg 10, 2333AA Leiden, The Netherlands.,Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2300RC Leiden, The Netherlands
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Lee K, van Nassau F, Grunseit A, Conte K, Milat A, Wolfenden L, Bauman A. Scaling up population health interventions from decision to sustainability - a window of opportunity? A qualitative view from policy-makers. Health Res Policy Syst 2020; 18:118. [PMID: 33036633 PMCID: PMC7547476 DOI: 10.1186/s12961-020-00636-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background While known efficacious preventive health interventions exist, the current capacity to scale up these interventions is limited. In recent years, much attention has focussed on developing frameworks and methods for scale-up yet, in practice, the pathway for scale-up is seldom linear and may be highly dependent on contextual circumstances. Few studies have examined the process of scaling up from decision to implementation nor examined the sustainability of scaled-up interventions. This study explores decision-makers’ perceptions from real-world scaled-up case studies to examine how scale-up decisions were made and describe enablers of successful scale-up and sustainability. Methods This qualitative study included 29 interviews conducted with purposively sampled key Australian policy-makers, practitioners and researchers experienced in scale-up. Semi-structured interview questions obtained information regarding case studies of scaled-up interventions. The Framework Analysis method was used as the primary method of analysis of the interview data to inductively generate common and divergent themes within qualitative data across cases. Results A total of 31 case studies of public health interventions were described by interview respondents based on their experiences. According to the interviewees’ perceptions, decisions to scale up commonly occurred either opportunistically, when funding became available, or when a deliberate decision was made and funding allocated. The latter scenario was more common when the intervention aligned with specific political or strategic goals. Decisions to scale up were driven by a variety of key actors such as politicians, senior policy-makers and practitioners in the health system. Drivers of a successful scale-up process included good governance, clear leadership, and adequate resourcing and expertise. Establishing accountability structures and appropriate engagement mechanisms to encourage the uptake of interventions were also key enablers. Sustainability was influenced by evidence of impact as well as good acceptability among the general or target population. Conclusions Much like Kingdon’s Multiple Streams Theory of ‘policy windows’, there is a conceptually similar ‘window for scale-up’, driven by a complex interplay of factors such as political need, strategic context, funding and key actors. Researchers and policy-makers need to consider scalability from the outset and prepare for when the window for scale-up opens. Decision-makers need to provide longer term funding for scale-up to facilitate longer term sustainability and build on the resources already invested for the scale-up process.
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Affiliation(s)
- Karen Lee
- School of Public Health, University of Sydney, Camperdown, NSW, 2050, Australia. .,The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia.
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne Grunseit
- School of Public Health, University of Sydney, Camperdown, NSW, 2050, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia
| | - Kathleen Conte
- The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia.,Menzies Centre for Health Policy, School of Public Health and the University Centre for Rural Health, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, New South Wales Ministry of Health, 100 Christie Street, St Leonards, NSW, 2065, Australia
| | - Luke Wolfenden
- The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia.,University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Camperdown, NSW, 2050, Australia.,The Australian Prevention Partnership Centre, Ultimo, NSW, 2007, Australia
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45
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Estabrooks PA, Harden SM, Almeida FA, Hill JL, Johnson SB, Porter GC, Greenawald MH. Using Integrated Research-Practice Partnerships to Move Evidence-Based Principles Into Practice. Exerc Sport Sci Rev 2020; 47:176-187. [PMID: 31008840 DOI: 10.1249/jes.0000000000000194] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The implementation of evidence-based physical activity interventions is improved when integrated research-practice partnerships are used. These partnerships consider both research- and practice-based evidence that moves beyond only assessing program efficacy. Our novel hypothesis is that integrated research-practice partnerships may lead to interventions that are practical and effective, reach more participants, and are more likely to be sustained in practice.
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Affiliation(s)
- Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Samantha M Harden
- Department of Human Nutrition, Foods, & Exercise, Virginia Tech, Blacksburg, VA
| | - Fabio A Almeida
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Jennie L Hill
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Sallie Beth Johnson
- Department of Health Sciences Administration, Jefferson College of Health Sciences, Roanoke, VA
| | - Gwenndolyn C Porter
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE
| | - Mark H Greenawald
- Department of Family and Community Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, VA
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Alvidrez J, Nápoles AM, Bernal G, Lloyd J, Cargill V, Godette D, Cooper L, Horse Brave Heart MY, Das R, Farhat T. Building the Evidence Base to Inform Planned Intervention Adaptations by Practitioners Serving Health Disparity Populations. Am J Public Health 2020; 109:S94-S101. [PMID: 30699023 DOI: 10.2105/ajph.2018.304915] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Many evidence-based interventions (EBIs) have been developed to prevent or treat major health conditions. However, many EBIs have exhibited limited adoption, reach, and sustainability when implemented in diverse community settings. This limitation is especially pronounced in low-resource settings that serve health disparity populations. Often, practitioners identify problems with existing EBIs originally developed and tested with populations different from their target population and introduce needed adaptations to make the intervention more suitable. Although some EBIs have been extensively adapted for diverse populations and evaluated, most local adaptations to improve fit for health disparity populations are not well documented or evaluated. As a result, empirical evidence is often lacking regarding the potential effectiveness of specific adaptations practitioners may be considering. We advocate an expansion in the emphasis of adaptation research from researcher-led interventions to research that informs practitioner-led adaptations. By presenting a research vision and strategies needed to build this area of science, we aim to inform research that facilitates successful adaptation and equitable implementation and delivery of EBIs that reduce health disparities.
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Affiliation(s)
- Jennifer Alvidrez
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Anna María Nápoles
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Guillermo Bernal
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Jacqueline Lloyd
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Victoria Cargill
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Dionne Godette
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Lisa Cooper
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Maria Yellow Horse Brave Heart
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rina Das
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tilda Farhat
- Jennifer Alvidrez, Anna María Nápoles, Rina Das, and Tilda Farhat are with the National Institute on Minority Health and Health Disparities, National Institutes of Health (NIH), Bethesda, MD. Guillermo Bernal was with the Office of the President, Carlos Albizu University, San Juan, PR, during the time of essay preparation. Jacqueline Lloyd is with the National Institute on Drug Abuse, NIH. Victoria Cargill is with the Office of Research on Women's Health, NIH. Dionne Godette is with the Office of Disease Prevention, NIH. Lisa Cooper is with the Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD. Maria Yellow Horse Brave Heart is with the Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
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Zomahoun HTV, Ben Charif A, Freitas A, Garvelink MM, Menear M, Dugas M, Adekpedjou R, Légaré F. The pitfalls of scaling up evidence-based interventions in health. Glob Health Action 2020; 12:1670449. [PMID: 31575331 PMCID: PMC6781190 DOI: 10.1080/16549716.2019.1670449] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.
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Affiliation(s)
- Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - Mirjam Marjolein Garvelink
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Matthew Menear
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada
| | - Michèle Dugas
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada
| | - Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval , Quebec , QC , Canada.,Centre de recherche sur les soins et les services de première ligne - Université Laval (CERSSPL-UL), Université Laval , Quebec , QC , Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval , Quebec , QC , Canada.,Department of Family Medicine and Emergency Medicine, Université Laval , Quebec , QC , Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre , Quebec , QC , Canada
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Rhule ELM, Allotey PA. Researching social innovation: is the tail wagging the dog? Infect Dis Poverty 2020; 9:3. [PMID: 31931879 PMCID: PMC6958697 DOI: 10.1186/s40249-019-0616-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/09/2019] [Indexed: 11/27/2022] Open
Abstract
Background Social Innovation in health initiatives have the potential to address unmet community health needs. For sustainable change to occur, we need to understand how and why a given intervention is effective. Bringing together communities, innovators, researchers, and policy makers is a powerful way to address this knowledge gap but differing priorities and epistemological backgrounds can make collaboration challenging. Main text To overcome these barriers, stakeholders will need to design policies and work in ways that provide an enabling environment for innovative products and services. Inherently about people, the incorporation of community engagement approaches is necessary for both the development of social innovations and accompanying research methodologies. Whilst the 'appropriate' level of participation is linked to intended outcomes, researchers have a role to play in better understanding how to harness the power of community engagement and to ensure that community perspectives form part of the evidence base that informs policy and practice. Conclusions To effectively operate at the intersection between policy, social innovation, and research, all collaborators need to enter the process with the mindset of learners, rather than experts. Methods – quantitative and qualitative – must be selected according to research questions. The fields of implementation research, community-based participatory research, and realist research, amongst others, have much to offer. So do other sectors, notably education and business. In all this, researchers must assume the mantel of responsibility for research and not transfer the onus to communities under the guise of participation. By leveraging the expertise and knowledge of different ecosystem actors, we can design responsive health systems that integrate innovative approaches in ways that are greater than the sum of their parts.
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Affiliation(s)
- Emma L M Rhule
- United Nations University - International Institute for Global Health, Kuala Lumpur, Malaysia.
| | - Pascale A Allotey
- United Nations University - International Institute for Global Health, Kuala Lumpur, Malaysia
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Intervention Scalability Assessment Tool: A decision support tool for health policy makers and implementers. Health Res Policy Syst 2020; 18:1. [PMID: 31900230 PMCID: PMC6942323 DOI: 10.1186/s12961-019-0494-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background Promising health interventions tested in pilot studies will only achieve population-wide impact if they are implemented at scale across communities and health systems. Scaling up effective health interventions is vital as not doing so denies the community the most effective services and programmes. However, there remains a paucity of practical tools to assess the suitability of health interventions for scale-up. The Intervention Scalability Assessment Tool (ISAT) was developed to support policy-makers and practitioners to make systematic assessments of the suitability of health interventions for scale-up. Methods The ISAT was developed over three stages; the first stage involved a literature review to identify similar tools and frameworks that could be used to guide scalability assessments, and expert input to develop draft ISAT content. In the second stage, the draft ISAT tool was tested with end users. The third stage involved revising and re-testing the ISAT with end users to further refine the language and structure of the final ISAT. Results A variety of information and sources of evidence should be used to complete the ISAT. The ISAT consists of three parts. Part A: ‘setting the scene’ requires consideration of the context in which the intervention is being considered for scale-up and consists of five domains, as follows: (1) the problem; (2) the intervention; (3) strategic/political context; (4) evidence of effectiveness; and (5) intervention costs and benefits. Part B asks users to assess the potential implementation and scale-up requirements within five domains, namely (1) fidelity and adaptation; (2) reach and acceptability; (3) delivery setting and workforce; (4) implementation infrastructure; and (5) sustainability. Part C generates a graphical representation of the strengths and weaknesses of the readiness of the proposed intervention for scale-up. Users are also prompted for a recommendation as to whether the intervention (1) is recommended for scale-up, (2) is promising but needs further information before scaling up, or (3) does not yet merit scale-up. Conclusion The ISAT fills an important gap in applied scalability assessment and can become a critical decision support tool for policy-makers and practitioners when selecting health interventions for scale-up. Although the ISAT is designed to be a health policy and practitioner tool, it can also be used by researchers in the design of research to fill important evidence gaps.
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Sims-Gould J, McKay HA, Hoy CL, Nettlefold L, Gray SM, Lau EY, Bauman A. Factors that influence implementation at scale of a community-based health promotion intervention for older adults. BMC Public Health 2019; 19:1619. [PMID: 31795995 PMCID: PMC6889455 DOI: 10.1186/s12889-019-7984-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/21/2019] [Indexed: 11/19/2022] Open
Abstract
Background Despite the many known benefits of physical activity (PA), relatively few older adults are active on a regular basis. Older adult PA interventions delivered in controlled settings showed promising results. However, to achieve population level health impact, programs must be effectively scaled-up, and few interventions have achieved this. To effectively scale-up it is essential to identify contextual factors that facilitate or impede implementation at scale. Our aim is to describe factors that influence implementation at scale of a health promotion intervention for older adults (Choose to Move). This implementation evaluation complements our previously published study that assessed the impact of Choose to Move on older adult health indicators. Methods To describe factors that influenced implementation our evaluation targeted five distinct levels across a socioecological continuum. Four members of our project team conducted semi-structured interviews by telephone with 1) leaders of delivery partner organizations (n = 13) 2) recreation managers (n = 6), recreation coordinators (n = 27), activity coaches (n = 36) and participants (n = 42) [August 2015 – April 2017]. Interviews were audio-recorded and professionally transcribed and data were analyzed using framework analysis. Results Partners agreed on the timeliness and need for scaled-up evidence-based health promotion programs for older adults. Choose to Move aligned with organizational priorities, visions and strategic directions and was deemed easy to deliver, flexible and adaptable. Partners also noted the critical role played by our project team as the support unit. However, partners noted availability of financial resources as a potential barrier to sustainability. Conclusions Even relatively simple evidence-based interventions can be challenging to scale-up and sustain. To ensure successful implementation it is essential to align with multilevel socioecological perspectives and assess the vast array of contextual factors that are at the core of better understanding successful implementation.
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Affiliation(s)
- Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 7F-2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - Heather A McKay
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 7F-2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Christa L Hoy
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 7F-2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Lindsay Nettlefold
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 7F-2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Samantha M Gray
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 7F-2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Erica Y Lau
- Centre for Hip Health and Mobility, University of British Columbia and Vancouver Coastal Health Research Institute, 7F-2635 Laurel Street, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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