1
|
Rauwenhoff JCC, Bol Y, Peeters F, van Heugten CM. Acceptance and Commitment Therapy is feasible for people with acquired brain injury: A process evaluation of the BrainACT treatment. Clin Rehabil 2024; 38:530-542. [PMID: 38099720 PMCID: PMC10898201 DOI: 10.1177/02692155231218813] [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: 02/28/2023] [Accepted: 11/20/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the feasibility of Acceptance and Commitment Therapy for people with acquired brain injury. DESIGN A process evaluation of the BrainACT treatment was conducted alongside a randomised controlled trial. SETTING Psychology departments of hospitals and rehabilitation centres. SUBJECTS Tweny-seven participants with acquired brain injury and 11 therapists. INTERVENTION BrainACT is an Acceptance and Commitment Therapy adapted for the needs and possible cognitive deficits of people with acquired brain injury, provided in eight one-hour face-to-face or video-conference sessions. MEASUREMENTS The attendance and compliance rates, engagement, satisfaction, and perceived barriers and facilitators for delivery in clinical practice were investigated using semi-structured interviews with participants and therapists and therapy logs. RESULTS 212 of the 216 sessions in total were attended and 534 of the 715 protocol elements across participants and sessions were delivered. Participants were motivated and engaged. Participants and therapists were satisfied with the intervention and participants reported to have implemented skills in their daily routines acquired during therapy. Key strengths are the structure provided with the bus of life metaphor, the experiential nature of the intervention, and the materials and homework. Participants and therapists often preferred face-to-face sessions, however, when needed video-conferencing is a good alternative. CONCLUSION BrainACT is a feasible intervention for people with anxiety and depressive symptoms following acquired brain injury. However, when the content of the intervention is too extensive, we recommend adding two extra sessions.
Collapse
Affiliation(s)
- Johanne CC Rauwenhoff
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- School for Mental Health and Neuroscience,
Department of Neuropsychology and Psychopharmacology, Limburg Brain Injury Centre, Maastricht, the
Netherlands
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yvonne Bol
- Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen/Heerlen, the Netherlands
| | - Frenk Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- School for Mental Health and Neuroscience,
Department of Neuropsychology and Psychopharmacology, Limburg Brain Injury Centre, Maastricht, the
Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
2
|
Ismail MR, Gilliland JA, Matthews JI, Beverley J, Battram DS. Children's Perceptions of the Ontario Student Nutrition Program (OSNP) in Southwestern Ontario, Canada. CAN J DIET PRACT RES 2023; 84:171-175. [PMID: 36892257 DOI: 10.3148/cjdpr-2022-042] [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] [Indexed: 03/10/2023]
Abstract
Purpose: This study aimed to explore children's lived experiences with the Ontario Student Nutrition Program (OSNP), a free, school-based snack program implemented in elementary schools in Southwestern, Ontario, Canada, to gain insights into future school food programs (SFP).Methods: Focus group discussions (n=17) were conducted with 105 children in Grades 5 to 8 in seven elementary schools. Focus groups were audio-recorded, transcribed, and coded for themes using inductive content analysis.Results: Overall, children appreciated the OSNP and felt that it filled a need in students. Children also reported a willingness to try novel food items. For future SFPs, participants recommended that input be sought from children to ensure food preferences were considered. Children also discussed wanting more appealing food offerings that may include some choice. Finally, children also mentioned wanting a fair and equitable distribution of food in classrooms.Conclusions: Children appreciated the OSNP and reported benefits to themselves and their peers. They also provided some valuable recommendations for future SFPs. If a nationally funded SFP is to be considered in Canada, children expressed the need to make the program equitable, while still allowing schools the flexibility to meet their unique needs and preferences.
Collapse
Affiliation(s)
- Mariam R Ismail
- School of Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Jason A Gilliland
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; Department of Geography & Environment, Western University, London, ON, Canada; Department of Paediatrics, Western University, London, ON, Canada; School of Health Studies, Western University, London, ON, Canada; Children's Health Research Institute, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Human Environments Analysis Laboratory, London, ON, Canada
| | - June I Matthews
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
| | - Jennifer Beverley
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada
| | - Danielle S Battram
- School of Food and Nutritional Sciences, Brescia University College, London, ON, Canada; Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
| |
Collapse
|
3
|
Collado-Soler R, Alférez-Pastor M, Torres FL, Trigueros R, Aguilar-Parra JM, Navarro N. A Systematic Review of Healthy Nutrition Intervention Programs in Kindergarten and Primary Education. Nutrients 2023; 15:nu15030541. [PMID: 36771248 PMCID: PMC9921877 DOI: 10.3390/nu15030541] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Childhood obesity and overweight rates are increasing in an exponential way. This type of diet-related health problem has consequences, not only at present but also for children's future lives. For these reasons, it is very important to find a solution, which could be nutrition intervention programs. The main objective of this article is to investigate the effectiveness of nutrition intervention programs in children aged 3-12 around the world. We used SCOPUS, Web of Science, and PubMed databases to carry out this systematic review and we followed the PRISMA statement. Two authors conducted literature searches independently, finding a total of 138 articles. Finally, after a thorough screening, a total of 19 articles were selected for detailed analysis. The results show that, in general, nutrition intervention programs are effective in improving knowledge and behaviors about healthy habits, and, consequently, that the body mass index value is reduced. However, it is true that we found differences between the incomes of families and geographical areas. In conclusion, we encourage school centers to consider including these types of programs in their educational program and bring awareness of the importance of families too.
Collapse
Affiliation(s)
- Rocio Collado-Soler
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| | - Marina Alférez-Pastor
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| | - Francisco L. Torres
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| | - Rubén Trigueros
- Department of Language and Education, University of Antonio de Nebrija, 28015 Madrid, Spain
- Correspondence: (R.T.); (J.M.A.-P.)
| | - Jose M. Aguilar-Parra
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
- Correspondence: (R.T.); (J.M.A.-P.)
| | - Noelia Navarro
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| |
Collapse
|
4
|
Bôto JM, Marreiros A, Diogo P, Pinto E, Mateus MP. Health behaviours as predictors of the Mediterranean diet adherence: a decision tree approach. Public Health Nutr 2021; 25:1-13. [PMID: 34369348 PMCID: PMC9991829 DOI: 10.1017/s1368980021003293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study aimed to identify health behaviours that determine adolescent's adherence to the Mediterranean diet (MD) through a decision tree statistical approach. DESIGN Cross-sectional study, with data collected through a self-fulfilment questionnaire with five sections: (1) eating habits; (2) adherence to the MD (KIDMED index); (3) physical activity; (4) health habits and (5) socio-demographic characteristics. Anthropometric and blood pressure data were collected by a trained research team. The Automatic Chi-square Interaction Detection (CHAID) method was used to identify health behaviours that contribute to a better adherence to the MD. SETTING Eight public secondary schools, in Algarve, Portugal. PARTICIPANTS Adolescents with ages between 15 and 19 years (n 325). RESULTS According to the KIDMED index, we found a low adherence to MD in 9·0 % of the participants, an intermediate adherence in 45·5 % and a high adherence in 45·5 %. Participants that regularly have breakfast, eat vegetable soup, have a second piece of fruit/d, eat fresh or cooked vegetables 1 or more times a day, eat oleaginous fruits at least 2 to 3 times a week, and practice sports and leisure physical activities outside school show higher adherence to the MD (P < 0·001). CONCLUSIONS The daily intake of two pieces of fruit and vegetables proved to be a determinant health behaviour for high adherence to MD. Strategies to promote the intake of these foods among adolescents must be developed and implemented.
Collapse
Affiliation(s)
- Joana Margarida Bôto
- University of Algarve – School of Health, Department of Dietetics and Nutrition, Gambelas Campus, 8005-139Faro, Portugal
| | - Ana Marreiros
- University of Algarve – School of Health, Department of Dietetics and Nutrition, Gambelas Campus, 8005-139Faro, Portugal
- Department of Biomedical Sciences and Medicine, Faro, Portugal
| | - Patrícia Diogo
- University of Algarve – School of Health, Department of Dietetics and Nutrition, Gambelas Campus, 8005-139Faro, Portugal
- Necton SA, Olhão, Algarve, Portugal
| | - Ezequiel Pinto
- University of Algarve – School of Health, Department of Dietetics and Nutrition, Gambelas Campus, 8005-139Faro, Portugal
- School of Health, Department of Dietetics and Nutrition, Faro, Portugal
- Centre for Health Studies and Development, Faro, Portugal
| | - Maria Palma Mateus
- University of Algarve – School of Health, Department of Dietetics and Nutrition, Gambelas Campus, 8005-139Faro, Portugal
- School of Health, Department of Dietetics and Nutrition, Faro, Portugal
| |
Collapse
|
5
|
Bast LS, Andersen HB, Andersen A, Lauemøller SG, Bonnesen CT, Krølner RF. School Coordinators' Perceptions of Organizational Readiness Is Associated with Implementation Fidelity in a Smoking Prevention Program: Findings from the X:IT II Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:312-323. [PMID: 33404969 PMCID: PMC8032573 DOI: 10.1007/s11121-020-01197-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
School organizational readiness to implement interventions may play an important role for the actual obtained implementation level, and knowledge about organizational readiness prior to intervention start can help pinpoint how to optimize support to the schools. In this study, we applied a novel heuristic, R = MC2 to assess school organizational readiness prior to implementation of a multicomponent smoking prevention program. Furthermore, we examined the association to actual implementation after the first year of study. We used questionnaire data from school coordinators at 40 schools in Denmark who had accepted to implement the multi-component smoking prevention intervention-X:IT II-in the school year 2017-2018 including three main components: (1) Rules on smoke-free school time, (2) A smoke-free curriculum, and (3) Parental involvement. On behalf of the school, a school coordinator answered a baseline questionnaire about the organizational readiness and a follow-up questionnaire about implementation of the three components after first year of study. Readiness was measured by summing aspects of motivation (relative advantage, compatibility, complexity, and priority), general capacity (culture, climate, and staff capacity), and innovation-specific capacity (knowledge, skills, and abilities). Based on school coordinators' perceptions, almost all schools had good general capacity while the other two areas of readiness varied across schools; overall, 56.8% of schools (N = 25) had good motivation for implementing the X:IT II intervention and 61.3% (N = 27) had high innovation-specific capacity. Half of the schools had high overall readiness defined as high motivation and high innovation-specific capacity. Schools with high overall readiness implemented the rules on smoke-free school time, smoke-free curriculum, and parental involvement to a higher degree than schools with low overall readiness. All participating schools possessed sufficient levels of general capacity, e.g., a well-functioning organizational culture and sufficient staff capacity. High levels of motivation and innovation-specific capacity were positively associated with the schools' actual implementation of the main intervention components. This way of conceptualizing and measuring organizational readiness may be useful in future studies, i.e., in studies where enhancing readiness is a main objective.
Collapse
|
6
|
Ismail MR, Seabrook JA, Gilliland JA. Process evaluation of fruit and vegetables distribution interventions in school-based settings: A systematic review. Prev Med Rep 2020; 21:101281. [PMID: 33364152 PMCID: PMC7753971 DOI: 10.1016/j.pmedr.2020.101281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
Assesses how school fruit & vegetable distribution interventions are implemented. Child fruit & vegetable intake is influenced by how intervention is implemented. Recommendations for implementing fruit & vegetable interventions in schools. Studies should also consider sustainability, cost-effectiveness and implementation.
Despite the importance of process evaluation in program evaluations, research has focused primarily on the effectiveness of fruit and vegetables (FVs) distribution interventions on children’s consumption, with little attention given to how these interventions achieve their outcomes. Five bibliographic databases (Embase, PubMed, ProQuest, Scopus, and Web of Science Core Collection) were searched in June 2019 for studies of interventions where the main focus was the implementation of distributed FVs to school-aged children as a snack. The Critical Appraisal Skills Programme (CASP) tool was used to appraise the risk of bias within included studies. Data were extracted based on study characteristics and findings. Results identified 24 studies reporting on 11 interventions and 1 policy. The findings of this systematic review indicate that the majority of the studies included limited references to implementation research. Recurring limitations include an absence of an evaluation theoretical framework and the data collection methods used. Also, several factors were identified as informing the success of snack-based FVs distribution programs, including participation of the school community, school characteristics, background knowledge, and parental engagement. Lack of timely FVs delivery, limited funding, inadequate awareness about the program, insufficient teachers’ time, and food waste were identified as challenges to successful programming. Findings indicate that distributing FVs to school-aged children as a snack can increase their consumption, but only with proper implementation. Further evaluative research is required to better inform future implementation of snack-based FV distribution interventions in school settings.
Collapse
Affiliation(s)
- Mariam R Ismail
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, Department of Paediatrics, Department of Epidemiology and Biostatistics, Human Environments Analysis Laboratory, Western University, Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Jason A Gilliland
- Department of Geography, School of Health Studies, Department of Paediatrics, Department of Epidemiology & Biostatistics, Human Environments Analysis Laboratory, Western University, Children's Health Research Institute, Lawson Health Research Institute, London, Ontario, Canada
| |
Collapse
|
7
|
Bonnesen CT, Jensen MP, Madsen KR, Toftager M, Rosing JA, Krølner RF. Implementation of initiatives to prevent student stress: process evaluation findings from the Healthy High School study. HEALTH EDUCATION RESEARCH 2020; 35:195-215. [PMID: 32219401 PMCID: PMC7243719 DOI: 10.1093/her/cyaa003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
Process evaluation of public health interventions is important for understanding intervention results and can help explain why interventions succeed or fail. This study evaluated implementation of a school-based intervention combining educational and environmental strategies to prevent stress among Danish high school students. We investigated dose delivered, dose received, fidelity, appreciation, barriers and facilitators at the 15 intervention schools using mixed methods and multiple data sources: questionnaires among students, teachers and school coordinators; semi-structured interviews with school coordinators; telephone interviews with student counsellors; and focus group interviews with students and teachers. Implementation varied by schools and classes. Half of the intervention schools delivered the environmental strategies. For the educational strategies, dose delivered differed according to intervention provider. Students reported a lower dose received compared with dose delivered reported by school staff. Overall, student counsellors, school coordinators and students-especially those with low perceived stress-were satisfied with the stress preventive initiatives while teacher satisfaction varied. Five main barriers and three facilitators for implementation were identified. The use of multiple data sources and data methods created new knowledge of the implementation process which is important for the interpretation of effect evaluation and development of future interventions.
Collapse
Affiliation(s)
- Camilla Thørring Bonnesen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Marie P Jensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Katrine R Madsen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Mette Toftager
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Johanne A Rosing
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Rikke F Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| |
Collapse
|
8
|
Hoekstra F, Hoekstra T, van der Schans CP, Hettinga FJ, van der Woude LHV, Dekker R. The implementation of a physical activity counseling program in rehabilitation care: findings from the ReSpAct study. Disabil Rehabil 2019; 43:1710-1721. [PMID: 31622120 DOI: 10.1080/09638288.2019.1675188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE This study aimed to evaluate the implementation of a physical activity counseling program in rehabilitation and to study heterogeneity in received counseling and investigate its association with changes in patients' physical activity outcomes. METHODS This prospective cohort study was conducted in 18 rehabilitation institutions. Data were collected using surveys completed by professionals (n= ±70) and patients (n = 1719). Implementation was evaluated using different process outcomes: reach, dosage, satisfaction, maintenance. Patients' physical activity outcomes included changes in total minutes/week of physical activity. Latent class analyses were conducted to identify profiles of received counseling characteristics and multilevel models were used to investigate associations with physical activity outcomes. RESULTS 5873 Patients were provided with motivational interviewing-based counseling after rehabilitation. Professionals and patients were positive about the program. Sixteen institutions (89%) formally agreed to continue the program. The four identified profiles of counseling characteristics illustrate a large variation in received counseling among patients. No substantial differences in physical activity outcomes were found between profiles. CONCLUSION After a three-year program period, the physical activity counseling centers were sustainably implemented in Dutch rehabilitation care. This study illustrated an innovative approach to assess heterogeneity in implementation outcomes (e.g., counseling profiles) in relation to program outcomes (e.g., physical activity).Implications for rehabilitationPhysical activity counseling after rehabilitation is important to support people with disabilities in making the step from rehabilitation-based physical activities to community-based physical activities.Establishing "Physical Activity Counseling Centers" is a promising "disability-overarching" strategy to promote physical activity after rehabilitation.Although the actual received counseling (dosage) varied among patients, this did not coincide with large differences in physical activity outcomes.The training in Motivational Interviewing, the financial incentives, and the advisory support were considered as important or essential ingredients for a successful implementation of the counseling program in rehabilitation practice.
Collapse
Affiliation(s)
- Femke Hoekstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Trynke Hoekstra
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cees P van der Schans
- Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.,Dept Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Florentina J Hettinga
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, United Kingdom
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rienk Dekker
- Center for Rehabilitation, Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | |
Collapse
|
9
|
The Association between Perceived Adequacy and Capacity for School Food Policy Implementation with Food Availability and Policy Adherence in Nova Scotia, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111974. [PMID: 31167362 PMCID: PMC6604017 DOI: 10.3390/ijerph16111974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/24/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022]
Abstract
Supporting the implementation of school food and nutrition policies is an international priority to encourage healthier eating among children and youth. Schools are an important intervention setting to promote childhood nutrition, and many jurisdictions have adopted policies, guidelines, and programs to modify the school nutrition environment and promote healthier eating. The purpose of this study was to explore the association between perceived adequacy of facilities or equipment and capacity of staff to support policy implementation with food availability and policy adherence in the province of Nova Scotia (NS), Canada, one of the first regions in Canada to launch a comprehensive school food and nutrition policy (SFNP). A cross-sectional online survey was conducted in 2014-2015 to provide a current-state assessment of policy implementation and adherence. Adequacy and capacity for food policy implementation was used to assess policy adherence through the availability of prohibited 'minimum' nutrition foods. An exploratory factor analysis was conducted on a selection of available foods, and 'slow'- and 'quick'-service food composition measures were dichotomized for food availability. Schools with above-average perceived adequacy and capacity for policy implementation had greater odds (OR = 3.62, CI = 1.56, 8.40) of adhering to a lunch policy, while schools that adhered to a snack and lunch policy had lower odds (OR = 0.48, CI = 0.23, 1.01 and OR = 0.18, CI = 0.08, 0.41) of serving quick-service foods. This study identified the need for appropriate adequacy of facilities or equipment and capacity of staff for policy implementation to ensure policy adherence and improve the school food environment. These findings highlight the relationship between school food and nutrition policies, suggesting that better supporting their implementation could increase the likelihood of their success.
Collapse
|
10
|
Understanding System-Level Intervention Points to Support School Food and Nutrition Policy Implementation in Nova Scotia, Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050712. [PMID: 30818856 PMCID: PMC6427736 DOI: 10.3390/ijerph16050712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Such policies can improve equitable access, resources, and supports for healthy eating. However, despite the potential impact of SFNPs, several implementation barriers have been reported. This study sought to examine the system-level intervention points within a school food system using a complex systems framework. We conducted semi-structured interviews with various stakeholders working to influence the school food system in Nova Scotia, Canada. We sought to understand their roles and experiences with the SFNP by applying the Intervention Level Framework (ILF), a novel, solutions-oriented approach to better understand how complex systems function. Participants (n = 33) included teachers, parents, cafeteria workers, public health staff and non-profit organizations. Interview transcripts were first coded, then themed and finally analyzed using the ILF, resulting in three intervention points within the school food system. These were defined as: (1) Actors and Elements, (2) System Regulation and Interconnections and (3) Purpose and Values. We concluded that understanding the interactions between these system levels and stakeholder roles can help to inform the development of relevant policy strategies that better support healthier school food environments in this jurisdiction.
Collapse
|
11
|
Levay AV, Chapman GE, Seed B, Wittman H. It's just the right thing to do: Conceptualizing a theory of change for a school food and beverage sales environment interv ention and implications for implementation evaluation. EVALUATION AND PROGRAM PLANNING 2018; 70:73-82. [PMID: 29866404 DOI: 10.1016/j.evalprogplan.2018.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 04/02/2018] [Accepted: 04/29/2018] [Indexed: 06/08/2023]
Abstract
School food environments are the target of nutrition interventions and evaluations across the globe. Yet little work to-date has articulated the importance of developing a theory of change upon which to base evaluation of both implementation and outcomes. This paper undertakes an interpretive approach to develop a retrospective theory of change for an implementation evaluation of British Columbia's school food and beverage sales Guidelines. This study contributes broadly to a nuanced conceptualization of this type of public health intervention and provides a methodological contribution on how to develop a retrospective theory of change with implications for effective evaluation. Data collection strategies included document analysis, semi-structured interviews with key stakeholders, and participant observation. Developing the logic model revealed that, despite the broad population health aims of the intervention, the main focus of implementation is to change behaviors of adults who create school food environments. Derived from the analysis and interpretation of the data, the emergent program theory focuses on the assumption that if adults are responsibilized through information and education campaigns and provided implementation tools, they will be 'convinced' to implement changes to school food environments to foster broader public health goals. These findings highlight the importance of assessing individual-level implementation indicators as well as the more often evaluated measures of food and beverage availability.
Collapse
Affiliation(s)
- Adrienne V Levay
- Integrated Studies in Land and Food Systems, Faculty of Land and Food Systems, University of British Columbia, Canada
| | - Gwen E Chapman
- College of Social and Applied Human Sciences, University of Guelph, Canada.
| | - Barbara Seed
- Independent Consultant in Food and Nutrition Policy, Canada
| | - Hannah Wittman
- Center for Sustainable Food Systems, Faculty of Land and Food Systems, University of British Columbia, Canada
| |
Collapse
|
12
|
McIsaac JLD, Spencer R, Chiasson K, Kontak J, Kirk SFL. Factors Influencing the Implementation of Nutrition Policies in Schools: A Scoping Review. HEALTH EDUCATION & BEHAVIOR 2018; 46:224-250. [PMID: 30173576 DOI: 10.1177/1090198118796891] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although school nutrition policies (SNPs) have been highlighted as an important intervention to support childhood nutrition, their implementation and maintenance within real-word settings is complex. There is a need to understand the factors that influence implementation by consolidating existing research and identifying commonalities and differences. AIMS The purpose of this review is to determine what is known about the influence of broad and local system factors on the implementation of SNPs internationally. METHOD This scoping review involved identifying and selecting relevant literature that related SNP implementation in primary and secondary schools. Following the search process, 2,368 articles were screened and 59 articles were synthesized and charted and emerging themes were identified. RESULTS Across the final studies identified, factors emerged as barriers and facilitators to the implementation of SNPs, with system implications that related to five areas to support policy action: providing macro-level support may encourage policy implementation; addressing the financial implications of healthy food access; aligning nutrition and core school priorities; developing a common purpose and responsibility among stakeholders; recognition of school and community characteristics. DISCUSSION While SNPs can help to support childhood nutrition, strategies to address issues related to policy implementation need to be taken to help schools overcome persistent challenges. CONCLUSION The results of this review provide opportunities for action across multiple system levels to ensure synergy and coordinated action toward SNP goals to foster the creation supportive nutrition environments for children.
Collapse
Affiliation(s)
- Jessie-Lee D McIsaac
- 1 Dalhousie University, Halifax, Nova Scotia, Canada.,2 Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | | | | | - Julia Kontak
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara F L Kirk
- 1 Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
13
|
Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review. Int J Behav Nutr Phys Act 2018; 15:75. [PMID: 30103764 PMCID: PMC6088402 DOI: 10.1186/s12966-018-0709-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
Background Until now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods. Methods Studies published between January 2001–October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4–18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (> 75% positive), moderate (50–75%) or low (< 50%). Results Of the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N = 50), followed by responsiveness (N = 36), adherence (N = 26) and quality of delivery (N = 8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n = 77). Conclusions There is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective. Electronic supplementary material The online version of this article (10.1186/s12966-018-0709-x) contains supplementary material, which is available to authorized users.
Collapse
|
14
|
Hoekstra F, van Offenbeek MAG, Dekker R, Hettinga FJ, Hoekstra T, van der Woude LHV, van der Schans CP. Implementation fidelity trajectories of a health promotion program in multidisciplinary settings: managing tensions in rehabilitation care. Implement Sci 2017; 12:143. [PMID: 29191230 PMCID: PMC5709964 DOI: 10.1186/s13012-017-0667-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although the importance of evaluating implementation fidelity is acknowledged, little is known about heterogeneity in fidelity over time. This study aims to generate insight into the heterogeneity in implementation fidelity trajectories of a health promotion program in multidisciplinary settings and the relationship with changes in patients' health behavior. METHODS This study used longitudinal data from the nationwide implementation of an evidence-informed physical activity promotion program in Dutch rehabilitation care. Fidelity scores were calculated based on annual surveys filled in by involved professionals (n = ± 70). Higher fidelity scores indicate a more complete implementation of the program's core components. A hierarchical cluster analysis was conducted on the implementation fidelity scores of 17 organizations at three different time points. Quantitative and qualitative data were used to explore organizational and professional differences between identified trajectories. Regression analyses were conducted to determine differences in patient outcomes. RESULTS Three trajectories were identified as the following: 'stable high fidelity' (n = 9), 'moderate and improving fidelity' (n = 6), and 'unstable fidelity' (n = 2). The stable high fidelity organizations were generally smaller, started earlier, and implemented the program in a more structured way compared to moderate and improving fidelity organizations. At the implementation period's start and end, support from physicians and physiotherapists, professionals' appreciation, and program compatibility were rated more positively by professionals working in stable high fidelity organizations as compared to the moderate and improving fidelity organizations (p < .05). Qualitative data showed that the stable high fidelity organizations had often an explicit vision and strategy about the implementation of the program. Intriguingly, the trajectories were not associated with patients' self-reported physical activity outcomes (adjusted model β = - 651.6, t(613) = - 1032, p = .303). CONCLUSIONS Differences in organizational-level implementation fidelity trajectories did not result in outcome differences at patient-level. This suggests that an effective implementation fidelity trajectory is contingent on the local organization's conditions. More specifically, achieving stable high implementation fidelity required the management of tensions: realizing a localized change vision, while safeguarding the program's standardized core components and engaging the scarce physicians throughout the process. When scaling up evidence-informed health promotion programs, we propose to tailor the management of implementation tensions to local organizations' starting position, size, and circumstances. TRIAL REGISTRATION The Netherlands National Trial Register NTR3961 . Registered 18 April 2013.
Collapse
Affiliation(s)
- Femke Hoekstra
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, PO Box 196, 9700, AD, Groningen, The Netherlands.
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Rienk Dekker
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Sports Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Florentina J Hettinga
- School of Biological Sciences, Center of Sport and Exercise Science, University of Essex, Colchester, UK
| | - Trynke Hoekstra
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, PO Box 196, 9700, AD, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, PO Box 196, 9700, AD, Groningen, The Netherlands
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cees P van der Schans
- Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
15
|
Wolfenden L, Nathan NK, Sutherland R, Yoong SL, Hodder RK, Wyse RJ, Delaney T, Grady A, Fielding A, Tzelepis F, Clinton‐McHarg T, Parmenter B, Butler P, Wiggers J, Bauman A, Milat A, Booth D, Williams CM. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease. Cochrane Database Syst Rev 2017; 11:CD011677. [PMID: 29185627 PMCID: PMC6486103 DOI: 10.1002/14651858.cd011677.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. OBJECTIVES The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. SEARCH METHODS All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. SELECTION CRITERIA 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. AUTHORS' CONCLUSIONS Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
Collapse
|
16
|
Nathan N, Wiggers J, Wyse R, Williams CM, Sutherland R, Yoong SL, Lecathelinais C, Wolfenden L. Factors associated with the implementation of a vegetable and fruit program in a population of Australian elementary schools. HEALTH EDUCATION RESEARCH 2017; 32:197-205. [PMID: 28380629 DOI: 10.1093/her/cyx038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 02/12/2017] [Indexed: 06/07/2023]
Abstract
Implementation of vegetable and fruit programs in schools is less than optimal. This study aimed to identify, using a theoretical framework, factors associated with implementation of a school vegetable and fruit program; that provides a time in class for children to consume a piece of vegetable or fruit they have brought from home. Three hundred and three randomly selected school principals across the state of New South Wales, Australia responded to a 25-min telephone survey. Principals were asked if their school had implemented a vegetable and fruit program, and which of 12 factors from Damschroder's consolidated framework for implementation research had facilitated or impeded implementation. Multiple logistic regression models examined the association between such factors and program implementation. Seventy-eight percent of schools had a vegetable and fruit program. Schools were significantly more likely to implement the program if the principal believed that: the program was effective (OR = 2.97; P < 0.02); they had sufficient resources to implement the program (OR = 4.22; P < 0.0001); the program would not be difficult to implement (OR = 10.16; P< 0.0001) and that the program was as important as other school priorities (OR = 2.45; P < 0.02). Realizing the intended benefits of vegetable and fruit programs requires widespread implementation by schools. Consideration of principal beliefs about the program effectiveness, resources, difficultly and relative importance in program implementation strategies appear key to increasing program implementation.
Collapse
Affiliation(s)
- N 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - J Wiggers
- 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - R Wyse
- 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - C M Williams
- 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - R 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - S L 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| | - C Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Locked Bag No 10, Wallsend, NSW 2287, Australia
| | - L 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, Newcastle, NSW 2308, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW 2308, Australia
- Hunter Medical Research Institute, Newcastle, NSW 2300, Australia
| |
Collapse
|
17
|
Jørgensen TS, Rasmussen M, Jørgensen SE, Ersbøll AK, Pedersen TP, Aarestrup AK, Due P, Krølner R. Curricular activities and change in determinants of fruit and vegetable intake among adolescents: Results from the Boost intervention. Prev Med Rep 2016; 5:48-56. [PMID: 27896044 PMCID: PMC5123064 DOI: 10.1016/j.pmedr.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 11/07/2016] [Accepted: 11/12/2016] [Indexed: 11/29/2022] Open
Abstract
Knowledge of the association between implementation of different intervention components and the determinants they are tailored to change may contribute to evaluating the effects and working mechanisms of multi-component interventions. This study examined 1) the effect of a Danish multi-component school-based intervention (2010 − 2011) on key determinants of adolescents' fruit and vegetable intake and 2) if dose of curricular activities was positively associated with change in these determinants. Using multi-level linear and logistic regression analyses stratified by gender and socioeconomic position, we analyzed survey data from the cluster-randomized Boost study targeting Danish 13-year-olds' fruit and vegetable intake. We examined 1) differences in knowledge of recommendations, taste preferences and situational norms between students from 20 intervention (n = 991) and 20 control (n = 915) schools at follow-up; and 2) associations between curriculum dose received and delivered (student and teacher data aggregated to school- and class-level) and these determinants among students at intervention schools only. At follow-up, more students from intervention than control schools knew the recommendation for vegetable intake (OR 1.56, CI:1.18, 2.06) and number of fruits liked (taste preferences) increased by 0.22 (CI:0.04, 0.41). At class-level, curriculum dose received was positively associated with proportion of students knowing the recommendation for vegetable intake (OR 1.06, CI:1.002, 1.13). In stratified analyses, this association was only significant among students from high social class (OR 1.17, CI:1.04, 1.31). The Boost intervention succeeded in improving students' taste preferences for fruit and knowledge of recommendation for vegetable intake, but only the latter determinant was positively associated with curriculum dose. Trial registration: ISRCTN11666034 Positive change in knowledge of recommendation for vegetable intake Positive change in taste preferences for fruit Knowledge of recommendation for vegetable intake was associated with curriculum dose
Collapse
Affiliation(s)
- Thea Suldrup Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
- Corresponding author at: National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark.National Institute of Public HealthUniversity of Southern DenmarkØster Farimagsgade 5A, 2nd floorCopenhagen K1353Denmark
| | - Mette Rasmussen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| | - Sanne Ellegaard Jørgensen
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| | - Trine Pagh Pedersen
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| | - Anne Kristine Aarestrup
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| | - Pernille Due
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| | - Rikke Krølner
- Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2nd floor, 1353 Copenhagen K, Denmark
| |
Collapse
|