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Hammersley ML, Wyse RJ, Jones RA, Okely AD, Wolfenden L, Eckermann S, Xu J, Green A, Stacey F, Yoong SL, Jackson J, Innes-Hughes C, Li V, Rissel C. Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial. J Med Internet Res 2022; 24:e35771. [PMID: 35616994 PMCID: PMC9185338 DOI: 10.2196/35771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few translational trials have provided detailed reports of process evaluation results. Objective This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Methods Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Results Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. Conclusions This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
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Affiliation(s)
- Megan L Hammersley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel A Jones
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Anthony D Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia.,Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Simon Eckermann
- Illawarra Health and Medical Research Institute, Wollongong, Australia.,School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Joe Xu
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, Australia
| | - Amanda Green
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Sze Lin Yoong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Jacklyn Jackson
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Christine Innes-Hughes
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, Australia
| | - Vincy Li
- Health Consult, Sydney, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Darwin, Australia
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2
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Koorts H, Maple JL, Eakin E, Lawrence M, Salmon J. Complexities and Context of Scaling Up: A Qualitative Study of Stakeholder Perspectives of Scaling Physical Activity and Nutrition Interventions in Australia. Front Public Health 2022; 10:771235. [PMID: 35419340 PMCID: PMC8995799 DOI: 10.3389/fpubh.2022.771235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/03/2022] [Indexed: 01/07/2023] Open
Abstract
Background Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder. Methods A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report “20 Questions for Developing a Scaling up Case Study”, and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically. Results Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the “Environment”, including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to “Scale up strategy” (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions. Conclusion Attributes of the “Environment” and “Scale up strategy” consistently featured as major influences on successful outcomes, while the role of evidence differed greatly between participant groups. A multisector scale up strategy for future interventions may enable the complexities of environmental and political contexts to be incorporated into scale up planning.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jaimie-Lee Maple
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Elizabeth Eakin
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Mark Lawrence
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
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3
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Weber P, Birkholz L, Kohler S, Helsper N, Dippon L, Ruetten A, Pfeifer K, Semrau J. Development of a Framework for Scaling Up Community-Based Health Promotion: A Best Fit Framework Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084773. [PMID: 35457644 PMCID: PMC9032469 DOI: 10.3390/ijerph19084773] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022]
Abstract
Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this qualitative review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion. First, we conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework. From 80 articles, a total of 12 frameworks were eligible, and 5 were included for data extraction. The analysis yielded 10 a priori defined key components: “innovation characteristics”; “clarify and coordinate roles and responsibilities”; “build up skills, knowledge, and capacity”; “mobilize and sustain resources”; “initiate and maintain regular communication”; “plan, conduct, and apply assessment, monitoring, and evaluation”; “develop political commitment and advocacy”; “build and foster collaboration”; “encourage participation and ownership”; and “plan and follow strategic approaches”. We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework. We further identified “encourage participation and ownership” as a crucial component regarding health equity.
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Flattum C, Friend S, Horning M, Lindberg R, Beaudette J, Fulkerson JA. Family-focused obesity prevention program implementation in urban versus rural communities: a case study. BMC Public Health 2021; 21:1915. [PMID: 34674674 PMCID: PMC8532281 DOI: 10.1186/s12889-021-11967-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. Methods This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. Results Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. Discussion When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.
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Affiliation(s)
- Colleen Flattum
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Suite 300, Minneapolis, MN, 55454, USA.
| | - Sarah Friend
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Horning
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Lee A, Stubbs C, Leonard D, Vidgen H, Minniecon D, Dick M, Cullerton K, Herron L. Rise and demise: a case study of public health nutrition in Queensland, Australia, over three decades. Health Promot Int 2021; 37:6378992. [PMID: 34597391 PMCID: PMC9067447 DOI: 10.1093/heapro/daab117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This case study describes the delivery and achievements of the public health nutrition programme in Queensland, Australia, over more than three decades. Analysis of publicly available documents related to statewide nutrition policy and programmes from 1983 to 2014 identified key inputs and programme impacts and outcomes, including an increase in fruit and vegetable intake by 1.1 serves per person per day and rates of exclusive breastfeeding for the first 6 months quadrupled. Mapping factors and milestones against a framework on determinants of political priority highlighted correlation with effective nutrition promotion policy and practice. Identified enablers included the influence of policy champions and advocates, quality of governance, focus on whole-of-population approaches, and periods of political will and economic prosperity. Key barriers included changes of ideology with government leadership; lack of commitment to long-term implementation and evaluation; and limited recognition of and support for preventive health and nutrition promotion. The case study shows that a coordinated, well-funded, intersectoral approach to improve nutrition and prevent chronic disease and malnutrition in all its forms can be achieved and produce promising impacts at state level, but that sustained effort is required to secure and protect investment. Political support for long-term investment in nutrition is essential to reduce the high cost of all diet-related diseases. Public health leadership to better prepare for risks around political cycles, secure adequate resources for evaluation, and better communicate impacts and outcomes may help protect future investments and achievements.
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Affiliation(s)
- Amanda Lee
- The School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, 4006, Australia
| | - Christina Stubbs
- Formerly Queensland Health (1986-2012), 33 Charlotte Street, Brisbane, 4001, Australia
| | - Dympna Leonard
- Australian Institute of Tropical Health and Medicine, James Cook University, 14 McGregor Road, Smithfield, Cairns, 4870, Australia
| | - Helen Vidgen
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Australia
| | - Deanne Minniecon
- Health and Wellbeing Queensland, 139 Coronation Drive, Milton, 4064, Australia
| | - Mathew Dick
- Health and Wellbeing Queensland, 139 Coronation Drive, Milton, 4064, Australia
| | - Katherine Cullerton
- The School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, 4006, Australia
| | - Lisa Herron
- The School of Public Health, The University of Queensland, 266 Herston Road, Brisbane, 4006, Australia
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6
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Hammersley ML, Wyse RJ, Jones RA, Stacey F, Okely AD, Wolfenden L, Batterham MJ, Yoong S, Eckermann S, Green A, Xu J, Innes-Hughes C, Jackson J, Li V, Rissel C. Translation of Two Healthy Eating and Active Living Support Programs for Parents of 2-6-Year-Old Children: Outcomes of the 'Time for Healthy Habits' Parallel Partially Randomised Preference Trial. Nutrients 2021; 13:3348. [PMID: 34684348 PMCID: PMC8539933 DOI: 10.3390/nu13103348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
This translation study assessed the effectiveness of two remotely delivered healthy eating and active living interventions for parents of 2- to 6-year-old children in improving child fruit and vegetable intake, non-core food intake, body mass index (BMI), physical activity, screen time, and sleep. Parents (n = 458) were recruited to a partially randomised preference trial comprising three intervention groups. Healthy Habits Plus comprised six telephone calls, Time2bHealthy comprised six online modules, and the active control comprised ten information sheets and a summary booklet. Data were collected from parents via a telephone questionnaire at baseline and nine months post-baseline. Data were analysed for randomised participants alone (n = 240), preference participants alone (n = 218), and all participants combined (n = 458). There was no significant improvement in fruit and vegetable intake (primary outcome) when comparing the telephone and online interventions to the control. In both the randomised only and all participants combined analyses, there was a significant improvement in non-core food intake for the telephone intervention compared to the control (p < 0.001). Differences between interventions for other outcomes were small. In conclusion, the telephone and online interventions did not improve child fruit and vegetable intake relative to written materials, but the telephone intervention did improve non-core food intake.
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Affiliation(s)
- Megan L. Hammersley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (R.A.J.); (A.D.O.)
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia;
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Rebecca J. Wyse
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (R.J.W.); (F.S.); (L.W.); (J.J.)
- Hunter New England Population Health, Wallsend, Newcastle, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Rachel A. Jones
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (R.A.J.); (A.D.O.)
- School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (R.J.W.); (F.S.); (L.W.); (J.J.)
- Hunter New England Population Health, Wallsend, Newcastle, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Anthony D. Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia; (R.A.J.); (A.D.O.)
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia;
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (R.J.W.); (F.S.); (L.W.); (J.J.)
- Hunter New England Population Health, Wallsend, Newcastle, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Marijka J. Batterham
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
- National Institute for Applied Statistics Research Australia, School of Maths and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Serene Yoong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, Melbourne, VIC 3122, Australia;
| | - Simon Eckermann
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW 2522, Australia;
- Illawarra Health and Medical Research Institute, Wollongong, NSW 2522, Australia;
| | - Amanda Green
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, NSW 2065, Australia; (A.G.); (J.X.); (C.I.-H.)
| | - Joe Xu
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, NSW 2065, Australia; (A.G.); (J.X.); (C.I.-H.)
| | - Christine Innes-Hughes
- Centre for Population Health, New South Wales Ministry of Health, St Leonards, Sydney, NSW 2065, Australia; (A.G.); (J.X.); (C.I.-H.)
| | - Jacklyn Jackson
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia; (R.J.W.); (F.S.); (L.W.); (J.J.)
- Hunter New England Population Health, Wallsend, Newcastle, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW 2305, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia
| | - Vincy Li
- HealthConsult, Sydney, NSW 2000, Australia;
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Darwin, NT 0800, Australia;
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7
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Koorts H, Cassar S, Salmon J, Lawrence M, Salmon P, Dorling H. Mechanisms of scaling up: combining a realist perspective and systems analysis to understand successfully scaled interventions. Int J Behav Nutr Phys Act 2021; 18:42. [PMID: 33752681 PMCID: PMC7986035 DOI: 10.1186/s12966-021-01103-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes. Methods A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions; Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up; Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions (Phase 1); and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up; validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data. Results Seven interventions were analysed, targeting nutrition (n = 1), physical activity (n = 1), or a combination (n = 5). Twenty-six participants completed surveys; 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes; linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included ‘intervention attributes’ and led to outcomes ‘community sustainability/embeddedness’ and ‘stakeholder buy-in/perceived value’. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability); mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability). Conclusion This paper provides the first evidence for mechanisms underpinning outcomes required for successful scale up of state or nationally delivered interventions. Our findings challenge current prerequisites for effective scaling suggesting other conditions may be necessary. Future scale up approaches that plan for complexity and encourage iterative adaptation throughout, may enhance scale up outcomes. Current linear, context-to-outcome depictions of scale up oversimplify what is a clearly a complex interaction between perceptions, worldviews and goals of those involved. Mechanisms identified in this study could potentially be leveraged during future scale up efforts, to positively influence intervention scalability and sustainability. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01103-0.
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Affiliation(s)
- Harriet Koorts
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia.
| | - Samuel Cassar
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Jo Salmon
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Mark Lawrence
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, VIC, Australia
| | - Paul Salmon
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, Business and Law, University of the Sunshine Coast, Queensland, Australia
| | - Henry Dorling
- Solent University, School of Sport, Health and Social Science, Southampton, Hampshire, UK
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8
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Seidler AL, Hunter KE, Johnson BJ, Ekambareshwar M, Taki S, Mauch CE, Mihrshahi S, Askie L, Campbell KJ, Daniels L, Taylor RW, Wen LM, Byrne R, Lawrence J, Perlstein R, Wardle K, Golley RK. Understanding, comparing and learning from the four EPOCH early childhood obesity prevention interventions: A multi-methods study. Pediatr Obes 2020; 15:e12679. [PMID: 32543054 DOI: 10.1111/ijpo.12679] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/06/2020] [Accepted: 05/08/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood obesity is a global problem. Early obesity prevention interventions are complex and differ in effectiveness. Novel frameworks, taxonomies and experience from the Early Prevention of Obesity in CHildren (EPOCH) trials were applied to unpack interventions. OBJECTIVES Deconstruct interventions into their components (target behaviours, delivery features and behaviour change techniques [BCTs]). Identify lessons learned and future recommendations for intervention planning, delivery, evaluation and implementation. METHODS This multi-methods study deconstructed the four EPOCH interventions into target behaviours, delivery features and BCTs from unpublished and published materials using systematic frameworks. Additionally, semi-structured interviews were conducted with intervention facilitators and principal investigators. RESULTS Each trial targeted between 10 and 14 obesity-related behaviours. Key variations in delivery features related to intensity, delivery mode and tailoring. BCTs consistently used across trials included goal-setting, social support, shaping knowledge, role-modelling and credible source. Recommendations from interview analyses include the importance of stakeholder collaboration and consideration of implementation throughout the study process. CONCLUSIONS The combination of frameworks, methodologies and interviews used in this study is a major step towards understanding complex early obesity prevention interventions. Future work will link systematic intervention deconstruction with quantitative models to identify which intervention components are most effective and for whom.
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Affiliation(s)
- Anna Lene Seidler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Kylie E Hunter
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Brittany J Johnson
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mahalakshmi Ekambareshwar
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Heath, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Heath, University of Sydney, Sydney, New South Wales, Australia.,Health Promotion Unit, Population Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Chelsea E Mauch
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Sydney School of Public Health, Faculty of Medicine and Heath, University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Lynne Daniels
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rachael W Taylor
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Li M Wen
- Sydney School of Public Health, Faculty of Medicine and Heath, University of Sydney, Sydney, New South Wales, Australia.,Health Promotion Unit, Population Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rebecca Byrne
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Julie Lawrence
- Department of Women's & Children's Health, University of Otago, Dunedin, New Zealand
| | - Robyn Perlstein
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Karen Wardle
- Health Promotion Unit, Population Health, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rebecca K Golley
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, New South Wales, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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9
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Hammersley ML, Wyse RJ, Jones RA, Wolfenden L, Yoong S, Stacey F, Eckermann S, Okely AD, Innes-Hughes C, Li V, Green A, May C, Xu J, Rissel C. Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial). BMC Public Health 2020; 20:636. [PMID: 32381052 PMCID: PMC7204000 DOI: 10.1186/s12889-020-08526-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background Parents are key decision makers and role models in establishing and maintaining healthy behaviours in their children. Interventions involving parents have been shown to be more effective than those that do not, but there are barriers to participation. Efficacy trials have previously been conducted on two such parent-focussed healthy eating and active living interventions with the potential to overcome these barriers - Healthy Habits (telephone-based) and Time2bHealthy (online) with promising results. Further research is now required to determine the effectiveness of these interventions in a real-world context. The Time for Healthy Habits study is a 3-arm partially randomised preference trial which aims to evaluate the effectiveness and cost-effectiveness of two theory-based programs to promote healthy eating and appropriate levels of movement behaviours (physical activity, sedentary behaviour and sleep) for parents of 2- to 6-year-old children (Healthy Habits Plus telephone-based program and Time2bHealthy online program), when compared to a comparison group receiving written materials. Methods Participants will be recruited across five Local Health Districts in New South Wales, Australia. The partially randomised preference design initially allows for participants to decide if they wish to be randomised or opt to select their preferred intervention and has been recommended for use to test effectiveness in a real-world setting. Both interventions incorporate multiple behaviour change techniques and support parents to improve their children’s healthy eating, and movement behaviours (physical activity, sedentary behaviour and sleep) and run for 12 weeks, followed by a 3-month and 9-month post-baseline follow-up. Participants will also be asked to complete a process evaluation questionnaire at the completion of the intervention (3-months post-baseline). Outcomes include fruit and vegetable intake (primary outcome), non-core food intake, weight status, physical activity, sedentary behaviour, and sleep habits. Discussion To our knowledge, this is the first translational research trial evaluating the effectiveness and cost-effectiveness of a healthy eating and active living intervention in the 2- to 6-years age group. The results will build the evidence base in regard to translation of effective childhood obesity prevention interventions and inform the implementation and delivery of community based childhood obesity prevention programs. Trial registration UTN: U1111–1228-9748, ACTRN: 12619000396123p.
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Affiliation(s)
- Megan L Hammersley
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia. .,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia.
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Rachel A Jones
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Fiona Stacey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Simon Eckermann
- Australian Health Services Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Anthony D Okely
- Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW, 2522, Australia.,Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW, 2522, Australia
| | - Christine Innes-Hughes
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Vincy Li
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Amanda Green
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Christine May
- Formerly Murrumbidgee Local Health District, Cootamundra Health Service, McKay St, Cootamundra, NSW, Australia
| | - Joe Xu
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Liverpool Hospital, Locked Bag 7103, Liverpool BC, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
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10
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Bell LK, Golley R, Moores CJ, Perry R, Hartley J, Miller M, Matwiejczyk L, Miller J, Magarey AM. Feasibility of a Group-Based, Facilitator-Directed Online Family Lifestyle Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1194-1201. [PMID: 31471067 DOI: 10.1016/j.jneb.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 07/09/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aimed to overcome barriers to access and attendance, and improve recruitment and engagement, through delivery and evaluation of the Parenting, Eating and Activity for Child Health (PEACH) child weight management program, as a facilitated group-based online healthy lifestyle program, PEACH Lifestyle. METHODS Pre-post feasibility study of an online intervention comprising a website with 10 self-directed learning modules and 6 facilitated group-based video conferencing sessions with parents (n = 79) of children (7.9 ± 2.9 years, 25% healthy weight, 23% obese). RESULTS Three enrollees were from remote locations. Half of the parents (n = 38) attended ≥1 video conferencing session (median = 3 participants per session [Range, 0-7]). Thirty percent (n = 7 of 21) completed all 10 online modules. Technical issues, time, and family commitments were barriers to engagement. CONCLUSIONS AND IMPLICATIONS Reframing and delivering a weight management program as a healthy lifestyle program online in real-time did not address barriers to engagement in PEACH Lifestyle.
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Affiliation(s)
- Lucinda K Bell
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.
| | - Rebecca Golley
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Carly J Moores
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Rebecca Perry
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Jo Hartley
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Micelle Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Louisa Matwiejczyk
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Jacqueline Miller
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia; Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Anthea M Magarey
- Department of Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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11
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Esdaile E, Hernandez E, Moores CJ, Vidgen HA. Enrolment of families with overweight children into a program aimed at reducing childhood obesity with and without a weight criterion: a natural experiment. BMC Public Health 2019; 19:756. [PMID: 31200674 PMCID: PMC6570944 DOI: 10.1186/s12889-019-6894-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Difficulties engaging families with overweight children to enrol into programs aimed at reducing childhood obesity have been well documented. During the implementation of the Parenting, Eating and Activity for Child Health Program (PEACH™) over a large geographical area (Queensland (QLD), Australia), a natural experiment developed. This experiment provided an opportunity to observe if there was a difference in enrolment for families with overweight children with a weight criterion (referred to as the period with a Targeted Eligibility Criterion (TEC)) compared to when a weight criterion was removed (the period referred to as Universal Eligibility Criterion (UEC)). We also examined the eligibility criterion's relationship with attendance, parental concern about their child's weight, estimation of overweight and obesity from parent-reported data. METHODS A secondary analysis of baseline data from 926 overweight/obese children from 817 families enrolled in PEACH™ QLD was performed. Analyses were adjusted to control for the presence of clustered data. Bivariate statistics were performed using Pearson chi-square test with the second-order Rao-Scott correction, and Mann-Whitney U-test for non-parametric continuous variables. Generalized Estimating Equations (GEE) explored the association between weight status-based eligibility criteria and enrolment of overweight children. GEE were adjusted for sex, age and socioeconomic index and stratified for weight category. RESULTS Compared to obese children, overweight children were almost twice as likely to be enrolled when the program did not have weight status-based eligibility criteria (during UEC period) (OR = 1.90 (CI 95% 1.35-2.68, p < 0.001)). Parents of overweight children enrolled during the UEC period were more likely to regard their child's weight as less of a concern than during the TEC period (UEC 67% vs. TEC 45%, p = 0.036). Children whose parent-reported data underestimated their weight category were more likely to be enrolled while the program did not have weight-related eligibility criteria OR = 2.27 (CI 1.38-3.70, p < 0.01). Program session attendance did not appear to be impacted by the changes in eligibility criteria. CONCLUSIONS The omission of weight criteria for healthy lifestyle programs is a consideration for health professionals and decision-makers alike when encouraging the enrolment of children who are overweight into healthy lifestyle programs. TRIAL REGISTRATION ACTRN12617000315314 . Retrospectively registered 28 February 2017.
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Affiliation(s)
- Emma Esdaile
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland Qld 4059 Australia
| | - Emely Hernandez
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland Qld 4059 Australia
| | - Carly Jane Moores
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - Helen Anna Vidgen
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland Qld 4059 Australia
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12
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Don't lose sight of the forest for the trees: recognising the benefits as well as the limitations of implementation research. Br J Nutr 2018; 121:63-64. [PMID: 30394229 DOI: 10.1017/s0007114518002982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Vidgen HA, Love PV, Wutzke SE, Daniels LA, Rissel CE, Innes-Hughes C, Baur LA. A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia. Implement Sci 2018; 13:109. [PMID: 30086782 PMCID: PMC6081901 DOI: 10.1186/s13012-018-0801-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background The prevalence of childhood obesity poses an urgent global challenge. The World Health Organization (WHO) Commission on Ending Childhood Obesity recommends the provision of appropriate family-based, lifestyle weight management services through universal health care to support families of children with overweight or obesity; however, there are few examples of their implementation ‘at scale’. The purpose of this research was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation. Methods Purposeful stratified sampling was used to select health service study sites (n = 16) representative of program implementation (none, discontinued, repeated) and geographic location within each State. Within each health service site, staff involved in program delivery, co-ordination and management roles participated (n = 39). An additional 11 staff involved in implementation at State level also participated. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview scripts. Telephone interviews were recorded and transcribed. Transcripts were thematically coded and scored according to CFIR constructs and rating rules to identify enablers and barriers to implementation according to sample characteristics. Results New South Wales achieved ongoing implementation; Queensland did not. Enablers included a quality evidence-based program, State government recognition of the urgency of the health issue and a commitment to address it, formally appointed and funded internal implementation leaders, strong communication and reporting at all levels. Barriers included the complexity of the health issue, in particular a lack of clear roles and responsibilities for local health service delivery, inadequate ongoing funding and challenges in meeting the diverse needs of families. Conclusions This research is an important progression of the evidence base in relation to the translation of childhood obesity management trials into routine health service delivery. Understanding enablers and barriers to program implementation ‘at scale’ is imperative to inform future planning and investment by Australia and WHO member states to meet their commitment to deliver childhood weight management services as part of universal health coverage. Electronic supplementary material The online version of this article (10.1186/s13012-018-0801-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen A Vidgen
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, 4059, QLD, Australia.
| | - Penelope V Love
- Institute of Physical Activity and Nutrition, Faculty of Health, Deakin University, Locked Bag 20001, Geelong, 3220, VIC, Australia
| | - Sonia E Wutzke
- The Australian Prevention Partnership Centre, PO Box K617, Haymarket, Sydney, 1240, NSW, Australia
| | - Lynne A Daniels
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, 4059, QLD, Australia
| | - Chris E Rissel
- NSW Office of Preventive Health, Locked Bag 7103, Liverpool BC, 1871, NSW, Australia
| | | | - Louise A Baur
- Discipline of Child and Adolescent Health, Clinical School, The Children's Hospital, University of Sydney, Locked Bag 4001, Westmead, 2145, NSW, Australia
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14
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Pre–post evaluation of a weight management service for families with overweight and obese children, translated from the efficacious lifestyle intervention Parenting, Eating and Activity for Child Health (PEACH). Br J Nutr 2018; 119:1434-1445. [DOI: 10.1017/s0007114518001083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractParenting, Eating and Activity for Child Health (PEACH) is a multi-component lifestyle intervention for families with overweight and obese children. PEACH was translated from an efficacious randomised-controlled trial (RCT) and delivered at scale as PEACH Queensland (QLD) in Queensland, Australia. The aim of this study is to explore pre–post changes in parenting, and child-level eating, activity and anthropometry, in the PEACH QLD service delivery project. PEACH QLD enrolled 926 overweight/obese children (817 families). Pre-programme evaluation was completed for 752 children and paired pre–post-programme evaluation data were available for 388 children. At baseline, children with pre–post-programme data were (mean) 8·8 years old, and at follow-up were 9·3 years old, with mean time between pre–post-programme measures of 0·46 years. Outcomes reflected each domain of the PEACH programme: parenting, eating behaviour of the child and activity behaviours (means reported). Parents reported improvements in parenting self-efficacy (3·6 to 3·7, P=0·001). Children had improved eating behaviours: eating more daily serves of vegetables (2·0 to 2·6, P=0·001) and fewer non-milk sweetened beverages (0·9 to 0·6, P=0·001) and discretionary foods (2·2 to 1·5, P=0·001). Children spent more time in moderate-to-vigorous physical activity (86 to 105 min/d, P=0·001) and less time in sedentary screen-based behaviours (190 to 148 min/d, P=0·001). Consequently, there were significant improvements in mean BMIz (−0·112; P<0·001) and weight status (healthy weight/overweight/obese/morbidly obese prevalence from 0/22/33/45 % to 2/27/34/37 %, P<0·001). When delivered at scale, PEACH remains an effective family-based, multi-component, lifestyle weight management programme for overweight and obese children whose families engage in the programme.
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