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Vogel C, Dijkstra C, Huitink M, Dhuria P, Poelman MP, Mackenbach JD, Crozier S, Seidell J, Baird J, Ball K. Real-life experiments in supermarkets to encourage healthy dietary-related behaviours: opportunities, challenges and lessons learned. Int J Behav Nutr Phys Act 2023; 20:73. [PMID: 37340326 DOI: 10.1186/s12966-023-01448-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Supermarkets are the primary source of food for many people yet their full potential as a setting to encourage healthy dietary-related behaviours remains underutilised. Sharing the experiences from research groups who have worked with supermarket chains to evaluate strategies that promote healthy eating could improve the efficiency of building such relationships and enhance the design quality of future research studies. METHODS A collective case study approach was used to synthesise experiences of engaging and sustaining research collaborations with national supermarket chains to test the effectiveness of health-focused in-store interventions. The collective narrative covers studies conducted in three high-income countries: Australia, the Netherlands and the United Kingdom. RESULTS We have distilled our experiences and lessons learned into six recommendations for conducting high quality public health research with commercial supermarket chains. These include: (i) using personal contacts, knowledge of supermarket activities and engaging executive management to establish a partnership and allowing time to build trust; (ii) using scientifically robust study designs with appropriate sample size calculations; (iii) formalising data exchange arrangements and allocating adequate resource for data extraction and re-categorisation; (iv) assessing effects at individual/households level where possible; (v) designing a mixed-methods process evaluation to measure intervention fidelity, dose and unintended consequences; and (vi) ensuring scientific independence through formal contract agreements. CONCLUSIONS Our collective experiences of working in non-financial partnerships with national supermarket chains could be useful for other research groups looking to develop and implement supermarket studies in an efficient manner. Further evidence from real-life supermarket interventions is necessary to identify sustainable strategies that can improve population diet and maintain necessary commercial outcomes.
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Affiliation(s)
- Christina Vogel
- Centre for Food Policy, City, University of London, Northampton Square, London, EC1V 0HB, UK.
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
| | - Coosje Dijkstra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Marlijn Huitink
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Maartje P Poelman
- Chair group Consumption and Healthy Lifestyles, Wageningen University & Research, P.O. Box 8130, Wageningen, 6700 EW, The Netherlands
| | - Joreintje D Mackenbach
- Department of Epidemiology and Data Science, Amsterdam UMC, location VUmc, Amsterdam Public Health research institute, De Boelelaan 1089a, 1081HV, Amsterdam, the Netherlands
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
| | - Jacob Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital Tremona Road, Southampton, SO16 6YD, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Ruiter ELM, Molleman GRM, Kleinjan M, Kraiss JT, ten Klooster PM, van der Velden K, Engels RCME, Fransen GAJ. The effectiveness of a web-based Dutch parenting program to prevent overweight in children 9-13 years of age: Results of a two-armed cluster randomized controlled trial. PLoS One 2022; 17:e0276168. [PMID: 36269738 PMCID: PMC9586369 DOI: 10.1371/journal.pone.0276168] [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: 09/29/2021] [Accepted: 08/30/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Although parental support is an important component in programs designed to prevent overweight in children, current programs pay remarkably little attention to the role of parenting. We therefore developed a web-based parenting program entitled "Making a healthy deal with your child". This e-learning program can be incorporated into existing overweight prevention programs. The aim of this study was to determine the effectiveness of this e-learning program. MATERIALS AND METHODS The effectiveness was examined in a two-armed cluster randomized controlled trial. The participants were 475 parent-child dyads of children 9-13 years of age in the Netherlands who participated in an existing schoolclass-based overweight prevention program. At the school grade level, parents were randomly assigned to either the intervention or the control condition. Measurements were taken from both parents and children at baseline, and 5 and 12 months after baseline. Primary outcomes included the child's dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices, and parental self-efficacy. Linear mixed effects models and generalized linear mixed effects models were conducted in R. RESULTS Intention-to-treat analyses and completers only revealed no significant effects between the intervention and control condition on energy balance-related behaviors of the child and parenting skills after correction for multiple testing. The parents' mean satisfaction with the e-learning program (on a 10-point scale) was 7.0±1.1. CONCLUSIONS Although parents were generally satisfied with the parenting program, following this program had no significant beneficial effects regarding the children's energy balance-related behaviors or the parenting skills compared to the control condition. This program may be more beneficial if used by high-risk groups (e.g. parents of children with unhealthy energy balance-related behaviors and/or with overweight) compared to the general population, warranting further study.
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Affiliation(s)
- Emilie L. M. Ruiter
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
- * E-mail:
| | - Gerard R. M. Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | | | - Jannis T. Kraiss
- Department of Psychology, Health and Technology, University of Twente, AE Enschede, The Netherlands
| | - Peter M. ten Klooster
- Department of Psychology, Health and Technology, University of Twente, AE Enschede, The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
| | | | - Gerdine A. J. Fransen
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, ELG 117, Radboud University Medical Center, HB Nijmegen, The Netherlands
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Ruiter ELM, Molleman GRM, Fransen GAJ, Wagenaar M, van der Velden K, Engels RCME. A set of pedagogical recommendations for improving the integrated approach to childhood overweight and obesity: A Delphi study. PLoS One 2020; 15:e0231245. [PMID: 32339183 PMCID: PMC7185684 DOI: 10.1371/journal.pone.0231245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 03/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Tackling the increasing global problem of childhood overweight and obesity requires an integrated approach. Studies increasingly emphasize the importance of the parents’ role in interventions designed to prevent overweight in children. The aim of this study was to develop a unified set of recommendations for healthy parenting practices that can be applied by all professionals who work with children age 4–13 years and can contribute to strengthening the integrated approach to childhood overweight. Methods A modified Delphi procedure was used to reach consensus regarding what these pedagogical recommendations should encompass. The 30 panelists were professionals and researchers who work with children age 4–13 in the domains of health care, overweight, parenting, education, nutrition, and/or sports. The procedure consisted of: i) extracting existing pedagogical recommendations from national guidelines and professional protocols, ii) appraising and prioritizing these recommendations in terms of relevance through two rounds of questionnaires, and iii) meeting to discuss and approve the set of recommendations. Results Consensus was reached for one set of eleven pedagogical theme-based recommendations designed to support and instruct parents how to stimulate healthy energy balance‒related behaviors in their child. Each recommendation contained information regarding: i) which behaviors in the child and/or parent are important, ii) why this is important, and iii) how parents can stimulate this behavior by applying parenting skills in daily life. The eleven themes were: modeling, positive parenting, breakfast, varied diet, sugar-sweetened beverages, snacks, physical activity, playing sports, quantity of screen time, screen time during meals, and sleep. Conclusion We developed a set of recommendations for healthy parenting that can be used by various professionals working with children age 4–13 and can contribute to creating an integrated approach to childhood overweight. We also developed a web-based app called “Recommendations for Healthy Parenting” as a convenient tool for following these recommendations.
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Affiliation(s)
- Emilie L. M. Ruiter
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, Radboud University Medical Center, Nijmegen, the Netherlands
- * E-mail:
| | - Gerard R. M. Molleman
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerdine A. J. Fransen
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marlijn Wagenaar
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Academic Collaborative Center AMPHI, Integrated Health Policy, Radboud University Medical Center, Nijmegen, the Netherlands
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Ruiter ELM, Saat JJEH, Molleman GRM, Fransen GAJ, van der Velden K, van Jaarsveld CHM, Engels RCME, Assendelft WJJ. Parents' underestimation of their child's weight status. Moderating factors and change over time: A cross-sectional study. PLoS One 2020; 15:e0227761. [PMID: 31945129 PMCID: PMC6964904 DOI: 10.1371/journal.pone.0227761] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 12/28/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Parents' underestimation of their child's weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents' perception of their child's weight status and the child's actual weight status, moderating factors, and change over time. METHODS This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2-12 years in the Netherlands. Parents classified their perception of their child's weight status on a 5-point Likert scale. In 2009 and 2013, the child's BMI was calculated from self-reported data by parents. The level of agreement between the parent's perception of the weight status and the actual weight status was examined using Cohen's kappa. The role of demographic factors on parents' perception were examined using logistic regression. RESULTS In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents' perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents' underestimation of their child's overweight/obesity status was associated with the child's age in 2009 and 2013 (2-7 years; OR: 0.18), the child's gender in 2009 (male; OR: 0.55), and the parents' education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively). CONCLUSIONS Parents' underestimation of their child's weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children.
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Affiliation(s)
- Emilie L. M. Ruiter
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands
| | - Jenneke J. E. H. Saat
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands
| | - Gerard R. M. Molleman
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands
| | - Gerdine A. J. Fransen
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands
| | - Koos van der Velden
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG, Radboud university medical center, HB Nijmegen, the Netherlands
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Windhorst DA, Fang Y, Fierloos IN, Crone MR, Van Mourik K, Jonkman H, Hosman CMH, Jansen W, Raat H. Evaluation of effectiveness of (elements of) parenting support in daily practice of preventive youth health care; design of a naturalistic effect evaluation in 'CIKEO' (consortium integration knowledge promotion effectiveness of parenting interventions). BMC Public Health 2019; 19:1462. [PMID: 31694586 PMCID: PMC6836651 DOI: 10.1186/s12889-019-7785-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of interventions to support parents is growing. The level of evidence regarding these intervention varies. In this paper we describe a study that aims to assess the effectiveness of specific 'elements' within such parenting interventions for families with children up to 7 years. A naturalistic effect evaluation will be applied. Study questions are: 1. What is the exposure of parents to (elements of) parenting interventions in the daily practice of preventive youth health care? 2. What are the associations between the exposure to (elements of) parenting interventions and outcomes in parents/children related to parenting and child development? METHODS/DESIGN Thousand parents/caregivers are recruited by preventive youth health care providers in the Netherlands. Measurements will be performed after inclusion and after 12-months follow up. Data regarding child/parent/caregiver characteristics, use of (parenting) interventions and care, and outcomes with regard to parenting skills, family functioning and child development will be collected. Outcomes will be compared between parents/children exposed and non-exposed to the (elements of) parenting interventions (adjusting for confounders). DISCUSSION We hypothesize that parents/caregivers with exposure to (elements of) parenting interventions show (relatively more) improvements in parenting outcomes. Results will support intervention selection/development, and support communities/professionals to select appropriate intervention-elements. TRIAL REGISTRATION Netherlands National Trial Register number NL7342 . Date of registration: 05-November-2018, retrospectively registered.
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Affiliation(s)
- Dafna A. Windhorst
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yuan Fang
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Irene N. Fierloos
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Matty R. Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Krista Van Mourik
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Clemens M. H. Hosman
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands
- Hosman Prevention and Innovation Consultancy, Bergen Dal, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
- Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Ruiter ELM, Fransen GAJ, Molleman GRM, Hoeijmakers MJHM, van der Velden K, Engels RCME. Everyday life situations in which mothers experience difficulty stimulating healthy energy balance-related behavior in their school-age children: a focus group study. BMC Public Health 2019; 19:701. [PMID: 31170950 PMCID: PMC6555719 DOI: 10.1186/s12889-019-6826-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parental support is an important element in overweight prevention programs for children. The purpose of this study was to examine everyday life situations in which mothers encounter difficulties encouraging healthy energy balance-related behavior in their school-age children. METHODS We formed four focus groups containing 6-9 participants each. The participants were mothers of Dutch, Turkish, or Moroccan descent with a child 8-13 years of age. All focus group sessions were recorded, transcribed, and coded. Content was analyzed conventionally using ATLAS.ti 6. RESULTS Twenty-seven difficult everyday life situations were identified in 14 settings. The five most frequently reported situations were a daily struggle regarding eating vegetables, eating breakfast on time before going to school, eating candy and snacks between meals, and spending excessive time watching television and using the computer. A perceived loss of parental control, the inability to establish rules and the failure to consistently enforce those rules were the most commonly cited reasons for why the mothers experience these situations as being difficult. CONCLUSIONS We identified five difficult everyday life situations related to healthy energy balance-related behavior. These five difficult situations were used as the input for developing a web-based parenting program designed to prevent children from becoming overweight. We reasoned that if we use these situations and the underlying reasons, many parents would recognize these situations and are willing to learn how to deal with them and complete the e-learning.
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Affiliation(s)
- Emilie L M Ruiter
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG 117, Radboud University Medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Gerdine A J Fransen
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG 117, Radboud University Medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Gerard R M Molleman
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG 117, Radboud University Medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Michelle J H M Hoeijmakers
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG 117, Radboud University Medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Koos van der Velden
- Academic Collaborative Center AMPHI, Integrated Health Policy, Department of Primary and Community Care, ELG 117, Radboud University Medical center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - Rutger C M E Engels
- Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands
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Murtagh EM, Barnes AT, McMullen J, Morgan PJ. Mothers and teenage daughters walking to health: using the behaviour change wheel to develop an intervention to improve adolescent girls' physical activity. Public Health 2018; 158:37-46. [PMID: 29544174 DOI: 10.1016/j.puhe.2018.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES The majority of adolescent girls fail to meet public health guidelines for physical activity. Engaging mothers in the promotion of physical activity for their daughters may be an important strategy to facilitate behaviour change. The aim of this study was to use the behaviour change wheel (BCW) framework to design the components of an intervention to improve adolescent girls' physical activity. STUDY DESIGN Cross-sectional study to inform intervention development. METHODS The BCW framework was used to (1) understand the behaviour, (2) identify intervention functions and (3) select content and implementation options. A circular development process was undertaken by the research team to collectively design the intervention in accordance with the steps recommended by the BCW. RESULTS The BCW design process resulted in the selection of six intervention functions (education, persuasion, incentivization, training, modelling, enablement) and 18 behaviour change techniques delivered via group-based, face-to-face mode. Behaviour change technique groupings include: goals and planning; feedback and monitoring; social support; shaping knowledge; natural consequences; comparison of behaviour; associations; comparison of outcomes; reward and threat; identity; and, self-belief. CONCLUSIONS The BCW process allowed an in-depth consideration of the target behaviours and provided a systematic framework for developing the intervention. The feasibility and preliminary efficacy of the programme will be examined.
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Affiliation(s)
- E M Murtagh
- Department of Arts Education & Physical Education, Mary Immaculate College, University of Limerick, Limerick, Ireland.
| | - A T Barnes
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - J McMullen
- School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO 80639, USA
| | - P J Morgan
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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van der Kleij RMJJ, Crone MR, Reis R, Paulussen TGWM. Critical stakeholder determinants to the implementation of intersectoral community approaches targeting childhood obesity. HEALTH EDUCATION RESEARCH 2016; 31:697-715. [PMID: 27923861 DOI: 10.1093/her/cyw047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an adapted version of the MIDI questionnaire, consisting of 18 theory-based constructs. A response rate of 62% was obtained. A hierarchical multivariate linear regression model was used to analyse our data; the final regression model predicted 65% of the variance in adherence. Higher levels of self-efficacy, being an implementer embedded in community B, and having more than 1 year of experience with IACO implementation were associated with higher degrees of adherence. Formal ratification of implementation by management and being prescribed a higher number of activities were related to lower degrees of adherence. We advise that, when designing implementation strategies, emphasis should be placed on the enhancement of professionals' self-efficacy, limitation of the number of activities prescribed and allocation of sufficient time to get acquainted and experienced with IACO implementation. Longitudinal studies are needed to further evaluate interaction between and change within critical determinants while progressing through the innovation process.
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Affiliation(s)
- R M J J van der Kleij
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - M R Crone
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - R Reis
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
- The Children s Institute, School of Child and Adolescent Health, University of Cape Town, South Africa
| | - T G W M Paulussen
- Research Group Lifestyle, Netherlands Organisation for Applied Scientific Research, ZL, 2316 Leiden, The Netherlands
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Barriers to and Facilitators of the Evaluation of Integrated Community-Wide Overweight Intervention Approaches: A Qualitative Case Study in Two Dutch Municipalities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:390. [PMID: 27043600 PMCID: PMC4847052 DOI: 10.3390/ijerph13040390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 12/25/2022]
Abstract
To prevent overweight and obesity the implementation of an integrated community-wide intervention approach (ICIA) is often advocated. Evaluation can enhance implementation of such an approach and demonstrate the extent of effectiveness. To be able to support professionals in the evaluation of ICIAs we studied barriers to and facilitators of ICIA evaluation. In this study ten professionals of two Dutch municipalities involved in the evaluation of an ICIA participated. We conducted semi-structured interviews (n = 12), observed programme meetings (n = 4) and carried out document analysis. Data were analyzed using a thematic content approach. We learned that evaluation is hampered when it is perceived as unfeasible due to limited time and budget, a lack of evaluation knowledge or a negative evaluation attitude. Other barriers are a poor understanding of the evaluation process and its added value to optimizing the programme. Sufficient communication between involved professionals on evaluation can facilitate evaluation, as does support for evaluation of ICIAs together with stakeholders at a strategic and tactical level. To stimulate the evaluation of ICIAs, we recommend supporting professionals in securing evaluation resources, providing tailored training and tools to enhance evaluation competences and stimulating strategic communication on evaluation.
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van der Kleij RMJJ, Crone MR, Paulussen TGWM, van de Gaar VM, Reis R. A stitch in time saves nine? A repeated cross-sectional case study on the implementation of the intersectoral community approach Youth At a Healthy Weight. BMC Public Health 2015; 15:1032. [PMID: 26449368 PMCID: PMC4597380 DOI: 10.1186/s12889-015-2306-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background The implementation of programs complex in design, such as the intersectoral community approach Youth At a Healthy Weight (JOGG), often deviates from their application as intended. There is limited knowledge of their implementation processes, making it difficult to formulate sound implementation strategies. Methods For two years, we performed a repeated cross-sectional case study on the implementation of a JOGG fruit and water campaign targeting children age 0–12. Semi-structured observations, interviews, field notes and professionals’ logs entries were used to evaluate implementation process. Data was analyzed via a framework approach; within-case and cross-case displays were formulated and key determinants identified. Principles from Qualitative Comparative Analysis (QCA) were used to identify causal configurations of determinants per sector and implementation phase. Results Implementation completeness differed, but was highest in the educational and health care sector, and higher for key than additional activities. Determinants and causal configurations of determinants were mostly sector- and implementation phase specific. High campaign ownership and possibilities for campaign adaptation were most frequently mentioned as facilitators. A lack of reinforcement strategies, low priority for campaign use and incompatibility of own goals with campaign goals were most often indicated as barriers. Discussion We advise multiple ‘stitches in time’; tailoring implementation strategies to specific implementation phases and sectors using both the results from this study and a mutual adaptation strategy in which professionals are involved in the development of implementation strategies. Conclusion The results of this study show that the implementation process of IACOs is complex and sustainable implementation is difficult to achieve. Moreover, this study reveals that the implementation process is influenced by predominantly sector and implementation phase specific (causal configurations of) determinants.
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Affiliation(s)
- Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Theo G W M Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands. .,TNO Research Group Lifestyle, Leiden, The Netherlands.
| | - Vivan M van de Gaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands. .,Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands. .,The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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Ruiter ELM, Fransen GAJ, Molleman GRM, van der Velden K, Engels RCME. The effectiveness of a web-based Dutch parenting program to prevent overweight in children 9-13 years of age: study protocol for a two-armed cluster randomized controlled trial. BMC Public Health 2015; 15:148. [PMID: 25884190 PMCID: PMC4335372 DOI: 10.1186/s12889-015-1394-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background Although parental support is an important component in overweight prevention programs for children, current programs pay remarkably little attention to the role of parenting. To close this gap, we developed a web-based parenting program for parents entitled “Making a healthy deal with your child”. This e-learning program can be incorporated into existing prevention programs, thereby improving these interventions by reinforcing the role of parenting and providing parents with practical tools for use in everyday situations in order to stimulate a healthy lifestyle. Here, we report the research design of a study to determine the effectiveness of our e-learning program. Methods/Design The effectiveness of an e-learning program was studied in a two-armed cluster randomized controlled trial. Parents of children 9–13 years of age who live in the Nijmegen region, the Netherlands, and who participated in the existing school-based overweight prevention program “Scoring for Health” were invited to participate in this study. Our goal was to recruit 322 parent–child dyads. At the school grade level, parents were randomly assigned to either the intervention group (which received e-learning and a brochure) or the control group (which received only the brochure); the participants were stratified by ethnicity. Measurements were taken from both the parents and the children at baseline, and then 5 and 12 months after baseline. Primary outcomes included the child’s dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices (e.g., set of rules, modeling, and monitoring), and parental self-efficacy. Discussion We hypothesize that children of parents who follow the e-learning program will have a healthier diet, will be less sedentary, and will have a higher level of physical activity compared to the children in the control group. If the e-learning program is found to be effective, it can be incorporated into existing overweight prevention programs for children (e.g., “Scoring for Health”), as well as activities regarding Youth Health Care. Trial registration Dutch Trial Register: NTR3938. Date of registration: April 7th, 2013.
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Affiliation(s)
- Emilie L M Ruiter
- Academic Collaborative Centre AMPHI, Primary Health Care, ELG 117, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Gerdine A J Fransen
- Academic Collaborative Centre AMPHI, Primary Health Care, ELG 117, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Gerard R M Molleman
- Academic Collaborative Centre AMPHI, Primary Health Care, ELG 117, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Koos van der Velden
- Academic Collaborative Centre AMPHI, Primary Health Care, ELG 117, Radboud University Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - Rutger C M E Engels
- Behavioral Science Institute, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, the Netherlands. .,Trimbos Institute, P.O. Box 725, 3500 AS, Utrecht, the Netherlands.
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