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Yudkin JS, Koym K, Hamad Y, Malthaner LQ, Burgess RM, Ortiz LN, Dhurjati N, Mitha S, Calvi G, Hill K, Brownell M, Wei E, Swartz K, Atem FD, Galeener CA, Messiah SE, Barlow SE, Allicock MA. Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework. Transl Behav Med 2024; 14:34-44. [PMID: 37632769 DOI: 10.1093/tbm/ibad051] [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: 08/28/2023] Open
Abstract
Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.
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Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kelsey Koym
- Texas Medical Center Library, Houston, TX, USA
| | - Yasmin Hamad
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Lauren Q Malthaner
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Rebecca Meredith Burgess
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Nalini Dhurjati
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sharmin Mitha
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Gabriela Calvi
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kristina Hill
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Elena Wei
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kyle Swartz
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
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Briatico D, Reilly KC, Tucker P, Irwin JD, Johnson AM, Pearson ES, Bock DE, Burke SM. Using the RE-AIM framework to evaluate the feasibility of a parent-focused intervention targeting childhood obesity. Pilot Feasibility Stud 2023; 9:38. [PMID: 36915150 PMCID: PMC10009980 DOI: 10.1186/s40814-023-01248-8] [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: 04/20/2022] [Accepted: 01/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Childhood obesity remains a serious public health concern. Community-based childhood obesity treatment interventions have the potential to improve health behaviors and outcomes among children, but require thorough evaluation to facilitate translation of research into practice. The purpose of the current study was to determine the feasibility of a community-based, parent-focused childhood obesity intervention ("C.H.A.M.P. Families") using the RE-AIM framework, an evaluation tool for health interventions. METHODS A single-group, non-randomized, repeated measures feasibility study was conducted. Participants (n = 16 parents/caregivers of 11 children with obesity) completed a 13-week parent-focused education intervention. The intervention consisted of three main components: (a) eight group-based (parent-only) education sessions; (b) eight home-based (family-centered) activities; and (c) two group-based follow-up support sessions for parents and children. The five dimensions of RE-AIM-reach, effectiveness, adoption, implementation, and maintenance-were assessed using various measures and data sources (e.g., child, parent/caregiver, costing, census) obtained throughout the study period. Outcome variables were measured at baseline, mid-intervention, post-intervention, and at a 6-month follow-up. RESULTS Overall, the C.H.A.M.P. Families intervention reached approximately 0.09% of eligible families in London, Ontario. Despite the small number, participants were generally representative of the population from which they were drawn, and program participation rates were high (reach). Findings also suggest that involvement in the program was associated with improved health-related quality of life among children (effectiveness/individual-level maintenance). In addition, the intervention had high fidelity to protocol, attendance rates, and cost-effectiveness (implementation). Lastly, important community partnerships were established and maintained (adoption/setting-level maintenance). CONCLUSIONS Based on a detailed and comprehensive RE-AIM evaluation, the C.H.A.M.P. Families intervention appears to be a promising parent-focused approach to the treatment of childhood obesity. TRIAL REGISTRATION ISRCTN Registry, Study ID ISRCTN 10752416 . Registered 24 April 2018.
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Affiliation(s)
- Daniel Briatico
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Kristen C Reilly
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Patricia Tucker
- Faculty of Health Sciences, Western University, London, Ontario, Canada.,Children's Health Research Institute, Lawson Health Research Institute, London, Canada
| | - Jennifer D Irwin
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Andrew M Johnson
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Erin S Pearson
- Faculty of Health and Behavioural Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Dirk E Bock
- Children's Health Research Institute, Lawson Health Research Institute, London, Canada.,Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Office for Child and Adolescent Medicine, Windisch, Aargau, Switzerland
| | - Shauna M Burke
- Faculty of Health Sciences, Western University, London, Ontario, Canada. .,Children's Health Research Institute, Lawson Health Research Institute, London, Canada.
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Lai J, Klag M, Shikako‐Thomas K. Designing a program evaluation for a medical-dental service for adults with autism and intellectual disabilities using the RE-AIM framework. Learn Health Syst 2019; 3:e10192. [PMID: 31317073 PMCID: PMC6628980 DOI: 10.1002/lrh2.10192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/27/2018] [Accepted: 03/10/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Robust evaluation of service models can improve the quality and efficiency of care while articulating the models for potential replication. Even though it is an essential part of learning health systems, evaluations that benchmark and sustain models serving adults with developmental disabilities are lacking, impeding pilot programs from becoming official care pathways. Here, we describe the development of a program evaluation for a specialized medical-dental community clinic serving adults with autism and intellectual disabilities in Montreal, Canada. METHOD Using a Participatory Action-oriented approach, researchers and staff co-designed an evaluation for a primary care service for this population. We performed an evaluability assessment to identify the processes and outcomes that were feasible to capture and elicited perspectives at both clinical and health system levels. The RE-AIM framework was used to categorize and select tools to capture data elements that would inform practice at the clinic. RESULTS We detail the process of conceptualizing the evaluation framework and operationalizing the domains using a mixed-methods approach. Our experience demonstrated (1) the utility of a comprehensive framework that captures contextual factors in addition to clinical outcomes, (2) the need for validated measures that are not cumbersome for everyday practice, (3) the importance of understanding the functional needs of the organization and building a sustainable data infrastructure that addresses those needs, and (4) the need to commit to an evolving, "living" evaluation in a dynamic health system. CONCLUSIONS Evaluation employing rigorous patient-centered and systems-relevant metrics can help organizations effectively implement and continuously improve service models. Using an established framework and a collaborative approach provides an important blueprint for a program evaluation in a learning health system. This work provides insight into the process of integrating care for vulnerable populations with chronic conditions in health care systems and integrated knowledge generation processes between research and health systems.
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Affiliation(s)
- Jonathan Lai
- Centre for Innovation in Autism and Intellectual DisabilitiesMiriam FoundationMontrealCanada
- School of Physical and Occupational TherapyMcGill UniversityMontrealCanada
| | - Malvina Klag
- Centre for Innovation in Autism and Intellectual DisabilitiesMiriam FoundationMontrealCanada
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Shaw RB, Sweet SN, McBride CB, Adair WK, Martin Ginis KA. Operationalizing the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework to evaluate the collective impact of autonomous community programs that promote health and well-being. BMC Public Health 2019; 19:803. [PMID: 31234804 PMCID: PMC6591988 DOI: 10.1186/s12889-019-7131-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services. Methods Criteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics. Results Having multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions. Conclusions The lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts. Electronic supplementary material The online version of this article (10.1186/s12889-019-7131-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert B Shaw
- School of Health & Exercise Sciences, University of British Columbia, 1147 Research Rd, Kelowna, British Columbia, V1V 1V7, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.
| | - Shane N Sweet
- Department of Kinesiology and Physical Education, McGill University, 475 Pine Ave W, Montreal, Quebec, H2W 1S4, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, 6363 Chemin Hudson (Pavillon Lindsay) suite 061, Montreal, Quebec, H3S 1M9, Canada
| | - Christopher B McBride
- Spinal Cord Injury BC, 780 SW Marine Drive, Vancouver, British Columbia, V6P 5Y7, Canada
| | - William K Adair
- Spinal Cord Injury Canada, 520 Sutherland Drive, Toronto, Ontario, M4G 3V9, Canada
| | - Kathleen A Martin Ginis
- School of Health & Exercise Sciences, University of British Columbia, 1147 Research Rd, Kelowna, British Columbia, V1V 1V7, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, 818 West 10th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada.,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, 2329 West Mall, Vancouver, British Columbia, V6T1Z4, Canada
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Participants' Perceptions of "C.H.A.M.P. Families": A Parent-Focused Intervention Targeting Paediatric Overweight and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122171. [PMID: 31248201 PMCID: PMC6617231 DOI: 10.3390/ijerph16122171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 01/07/2023]
Abstract
Background: Recently, our team implemented a 13-week group-based intervention for parents of children with obesity ("C.H.A.M.P. Families"). The primary objective of this study was to explore, qualitatively, parents' perspectives of their experiences in and influence of C.H.A.M.P. Families, as well as their recommendations for future paediatric obesity treatment interventions. Methods: Twelve parents (seven mothers, five fathers/step-fathers) representing seven children (four girls, three boys) with obesity participated in one of two focus groups following the intervention. Focus groups were audio recorded and transcribed verbatim and data were analyzed using inductive thematic analysis. Results: Findings showed that parents perceived their participation in C.H.A.M.P. Families to be a positive experience. Participants highlighted several positive health-related outcomes for children, families, and parents. Parents also underscored the importance and positive impact of the group environment, specific educational content, and additional program components such as free child-minding. Recommendations for future interventions were also provided, including greater child involvement and more practical strategies. Finally, parents identified several barriers including socioenvironmental issues, time constraints, and parenting challenges. Conclusions: Researchers developing family-based childhood obesity interventions should consider the balance of parent and child involvement, as well as emphasize group dynamics strategies and positive family communication.
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Lew MS, L'Allemand D, Meli D, Frey P, Maire M, Isenschmid B, Tal K, Molinari B, Auer R. Evaluating a childhood obesity program with the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Prev Med Rep 2019; 13:321-326. [PMID: 30792947 PMCID: PMC6369326 DOI: 10.1016/j.pmedr.2019.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 01/20/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022] Open
Abstract
Primary care providers can use behavioral lifestyle interventions to effectively treat children with overweight and obesity, but implementing these interventions is challenging. Most childhood obesity intervention evaluation studies focus on effectiveness. Few studies describe implementation. Our goal was to evaluate critical components of a childhood obesity intervention in primary care. We conducted a pilot implementation study of an existing structured lifestyle intervention in the Canton of Bern, Switzerland from 2013 to 2015. The intervention consisted of 10 sessions, led by a primary care physician. It included children aged 6–8 years old, with BMI over the 90th age-adjusted percentile. We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) evaluation framework to describe the pilot implementation study. We stratified description of RE-AIM components at the patient- and physician-level. For Reach: 864 children were screened; 65 were overweight; 394 physicians were invited to participate in the study. For Effectiveness: BMI z-score significantly decreased (−5.6%, p = 0.01). For Adoption: 14 participating physicians treated 26 patients. Implementation: the mean number of consultations was 8. For Maintenance: 9 (35%) children discontinued the intervention; 7 (50%) of physicians continued to apply at least one component of the intervention. The summarized components of the program within the RE-AIM framework suggest the program was successful. Stakeholders can use our results if they intend to disseminate and evaluate similar interventions in different settings. We describe the implementation process of a childhood obesity intervention. This might help stakeholders implement similar interventions in their setting. Using RE-AIM makes it easier to compare implementation of similar programs.
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Affiliation(s)
- Mei Sien Lew
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Dagmar L'Allemand
- Pädiatrische Endokrinologie/Diabetologie, Fachbereich Jugendmedizin, Ostschweizer Kinderspital, St. Gallen, Switzerland
| | | | - Peter Frey
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Micheline Maire
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Bettina Isenschmid
- Kompetenzzentrum für Essverhalten, Adipositas und Psyche, Spital Zofingen, Switzerland
| | - Kali Tal
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Beatrice Molinari
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Reto Auer
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.,Department of Community Medicine and Primary Care, University of Lausanne, Switzerland
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"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122858. [PMID: 30558152 PMCID: PMC6313348 DOI: 10.3390/ijerph15122858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/22/2022]
Abstract
Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.
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Gentile N, Kaufman TK, Maxson J, Klein DM, Merten S, Price M, Swenson L, Weaver AL, Brewer J, Rajjo T, Narr C, Ziebarth S, Lynch BA. The Effectiveness of a Family-Centered Childhood Obesity Intervention at the YMCA: A Pilot Study. JOURNAL OF COMMUNITY MEDICINE & HEALTH EDUCATION 2018; 8:591. [PMID: 29732240 PMCID: PMC5931388 DOI: 10.4172/2161-0711.1000591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Community-based, family-centered obesity prevention/treatment initiatives have been shown to be effective in reducing body mass index (BMI) and improving healthy habits in children if implemented with high intensity and sufficient duration. Let's Go! 5-2-1-0 Program (5-2-1-0) was incorporated into family-centered, monthly physical activity classes and cooking classes over six months delivered by Young Men's Christian Association (YMCA) staff. We hypothesized that implementation of this intervention would improve 5-2-1-0 knowledge attainment, increase healthy behavior (based on 5- 2-1-0 curriculum), and improve BMI and waist circumference measurements in children. METHODS Children attending YMCA summer camps in Rochester, MN, during 2016 were recruited via study packets mailed to their families. Height, weight, and waist circumference measurements as well as the results of the Modified Healthy Habits Survey and the 5-2-1-0 Knowledge Acquisition Survey were recorded for each participating child at baseline and 6-month follow-up. The intervention group received monthly healthy habit reminder emails, and was invited to monthly evening cooking and physical activity classes for 7 sessions over a 6-month period. RESULTS Fifteen families in the intervention group attended classes. Of those, 13 families regularly participated in (attended at least 5 out of 7) both the monthly physical activity and cooking classes. The children in the intervention group had a significant improvement in the number of Knowledge Acquisition Survey questions answered correctly (p<0.001), while there was no improvement in the control group. As compared to children in the control group, there was no significant change in BMI or waist circumference or healthy habits in the intervention group. CONCLUSION Our study findings indicate that our intervention resulted in improved knowledge about healthy habits, but did not significantly impact healthy habits or BMI. Potential reasons for this were the small sample size and the attenuated length and/or intensity of the intervention.
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Affiliation(s)
- N Gentile
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - TK Kaufman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Maxson
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - DM Klein
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Merten
- Viterbo University, La Crosse, WI, USA
| | - M Price
- Viterbo University, La Crosse, WI, USA
| | - L Swenson
- Office of Patient Education, Mayo Clinic, Rochester, MN, USA
| | - AL Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - J Brewer
- Rochester Area Family YMCA, Rochester, MN, USA
| | - T Rajjo
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Narr
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - S Ziebarth
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - BA Lynch
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
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Jung ME, Bourne JE, Gainforth HL. Evaluation of a community-based, family focused healthy weights initiative using the RE-AIM framework. Int J Behav Nutr Phys Act 2018; 15:13. [PMID: 29373975 PMCID: PMC5787319 DOI: 10.1186/s12966-017-0638-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background Childhood overweight and obesity is a major public health concern. Community-based interventions have the potential to reach caregivers and children. However, the overall health impact of these programs is rarely comprehensively assessed. This study evaluated a physical activity and healthy eating family program (Healthy Together; HT) using the RE-AIM framework. Methods Ten sites implemented the 5-week program. Thirty-nine staff members and 277 program participants (126 caregivers [Mage = 35.6] and 151 children [Mage = 13]) participated in the evaluation. Each RE-AIM dimension was assessed independently using a mixed-methods approach. Sources of data included archival records, interviews and surveys. Effectiveness outcome variables were assessed at pre- and post-intervention and 6-month follow-up. Results Reach: HT participants were almost entirely recruited from existing programs within sites. Effectiveness: Caregivers’ nutrition related efficacy beliefs increased following HT (ps < .03). Participation in HT was not associated with significant changes in physical activity or nutrition behaviour or perceived social support (ps > .05). Knowledge surrounding healthy diets and physical activity increased in children and caregivers (ps < .05). Adoption: Thirty-five percent of sites approached to implement HT expressed interest. The 10 sites selected recruited existing staff members to implement HT. Implementation: Program objectives were met 72.8% of the time and 71 adaptations were made. HT was finance- and time-dependent. Maintenance: Two sites fully implemented HT in the follow-up year and 5 sites incorporated aspects of HT into other programs. Conclusions Working alongside organizations that develop community programs to conduct comprehensive, arms-length evaluations can systematically highlight areas of success and challenges. Overall HT represents a feasible community-based intervention; however further support is required in order to ensure the program is effective at positively targeting the desired outcomes. As a result of this evaluation, modifications are currently being implemented to HT. Electronic supplementary material The online version of this article (10.1186/s12966-017-0638-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada.
| | - Jessica E Bourne
- Centre for Exercise, Nutrition and health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Heather L Gainforth
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, Canada
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Glasgow RE, Estabrooks PE. Pragmatic Applications of RE-AIM for Health Care Initiatives in Community and Clinical Settings. Prev Chronic Dis 2018; 15:E02. [PMID: 29300695 PMCID: PMC5757385 DOI: 10.5888/pcd15.170271] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) planning and evaluation framework has been applied broadly, but users often have difficulty in applying the model because of data collection needs across multiple domains and sources. Questions in the more common "who, what, where, how, when, and why" format may be an effective guide to ensure that individual participants, organization staff, and the perspectives of the setting are considered in planning and evaluation. Such a format can also help users in typical community and clinical settings to identify which outcomes are most valued and to focus limited measurement resources. Translations of RE-AIM that are easy to understand and apply are needed for application in real-world community and clinical settings where research and evaluation resources are limited. The purpose of this article is to provide simplified, pragmatic, user-centered and stakeholder-centered recommendations to increase the use of RE-AIM in community and clinical settings and in translational research.
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Affiliation(s)
- Russell E Glasgow
- University of Colorado School of Medicine, Department of Family Medicine, AO1, Mail Stop F496, P.O. Box 6511, Aurora, CO 80045.
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Truelove S, Johnson AM, Vanderloo LM, Driediger M, Burke SM, Irwin JD, Timmons BW, Gaston A, Tucker P. Preschoolers' health-related quality of life following the implementation of a childcare physical activity intervention. Appl Physiol Nutr Metab 2017; 43:453-459. [PMID: 29207249 DOI: 10.1139/apnm-2017-0396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Being active offers many physical and emotional benefits contributing to a higher health-related quality of life (HRQoL); however, this relationship remains unexplored among preschoolers (aged 2.5-5 years). This study examined the impact of the Supporting Physical Activity in the Childcare Environment (SPACE), which was an intervention implemented using a cluster randomized controlled trial on preschoolers' HRQoL. Childcare centres were randomly allocated to the experimental (n = 11) or control (n = 11) conditions, and preschoolers' HRQoL was measured using the parent-report Pediatric Quality of Life Inventory 4.0 (3 subscales: physical, psychosocial, and total HRQoL) at baseline, post-intervention (i.e., week 8), and 6- and 12-month follow-up. A linear mixed-effects model was used to determine if preschoolers in the experimental condition displayed an increased HRQoL post-intervention and at follow-up compared with preschoolers in the control condition. Preschoolers (n = 234) with HRQoL data at baseline and one additional time-point were retained for analyses. Body mass index was not found to impact significantly on the intervention, and no statistically significant interaction effects were found for any of the 3 HRQoL variables. In conclusion, the SPACE intervention had no impact on preschoolers' HRQoL. Given the scarcity of research in this population, additional exploration is necessary to better understand the potential impact of physical activity participation on preschoolers' HRQoL.
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Affiliation(s)
- Stephanie Truelove
- a Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada
| | - Andrew M Johnson
- b School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6G IH1, Canada
| | - Leigh M Vanderloo
- a Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada
| | - Molly Driediger
- c School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada
| | - Shauna M Burke
- b School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6G IH1, Canada
| | - Jennifer D Irwin
- b School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON N6G IH1, Canada
| | - Brian W Timmons
- d Child Health & Exercise Medicine Program, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Anca Gaston
- e School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada
| | - Patricia Tucker
- c School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, London, ON N6G 1H1, Canada
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12
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Moreno JP, Vézina-Im LA, Vaughan EM, Baranowski T. Impact of child summertime obesity interventions on body mass index, and weight-related behaviours: a systematic review and meta-analysis protocol. BMJ Open 2017; 7:e017144. [PMID: 29061614 PMCID: PMC5665220 DOI: 10.1136/bmjopen-2017-017144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION In previous studies, it has been found that on average, children consistently gained weight during the summer months at an increased rate compared with the 9-month school year. This contributed to an increased prevalence of overweight and obesity in children. Several obesity-related interventions have occurred during or targeting the summer months. We propose to conduct a systematic review and meta-analysis of the impact of obesity prevention and treatment interventions for school-age children conducted during the summer or targeting the summer months when children are not in school on their body mass index (BMI), or weight-related behaviours. METHODS AND ANALYSES A literature search will be conducted by the first author (JPM) using MEDLINE/PubMed, Cochrane Library, Scopus, CINAHL, PsycINFO, EMBASE and Proquest Dissertations and Theses databases from the date of inception to present. Studies must examine interventions that address the modification or promotion of weight-related behaviours (eg, dietary patterns, eating behaviours, physical activity (PA), sedentary behaviour or sleep) and target school-age children (ages 5-18). The primary outcomes will be changes from baseline to postintervention and/or the last available follow-up measurement in weight, BMI, BMI percentile, standardised BMI or per cent body fat. Secondary outcomes will include changes in dietary intake, PA, sedentary behaviour or sleep. Risk of bias will be assessed using the Cochrane risk of bias tool for randomised and non-randomised studies, as appropriate. ETHICS AND DISSEMINATION Because this is a protocol for a systematic review, ethics approval will not be required. The findings will be disseminated via presentations at scientific conferences and published in a peer-reviewed journal. All amendments to the protocol will be documented and dated and reported in the PROSPERO trial registry. PROSPERO REGISTRATION NUMBER CRD42016041750.
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Affiliation(s)
- Jennette P Moreno
- Department of Pediatrics-Nutrition, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Lydi-Anne Vézina-Im
- Department of Pediatrics-Nutrition, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | | | - Tom Baranowski
- Department of Pediatrics-Nutrition, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
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13
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Dhaliwal J, Perez AJ, Holt NL, Gokiert R, Chanoine JP, Morrison KM, Legault L, Sharma AM, Ball GD. Why do parents discontinue health services for managing paediatric obesity? A multi-centre, qualitative study. Obes Res Clin Pract 2017; 11:335-343. [DOI: 10.1016/j.orcp.2016.10.285] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/30/2016] [Accepted: 10/07/2016] [Indexed: 11/26/2022]
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14
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Reece LJ, Sachdev P, Copeland RJ, Thomson M, Wales JK, Wright NP. Intra-gastric balloon as an adjunct to lifestyle support in severely obese adolescents; impact on weight, physical activity, cardiorespiratory fitness and psychosocial well-being. Int J Obes (Lond) 2017; 41:591-597. [PMID: 27795553 PMCID: PMC5382282 DOI: 10.1038/ijo.2016.192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Severe adolescent obesity (body mass index (BMI) >99.6th centile) is a significant public health challenge. Current non-invasive treatments, including community-based lifestyle interventions, are often of limited effectiveness in this population, with NICE guidelines suggesting the use of bariatric surgery as the last line of treatment. Health professionals are understandably reluctant to commission bariatric surgery and as an alternative, the use of an intra-gastric balloon as an adjunct to a lifestyle programme might offer a reversible, potentially safer and less invasive option. OBJECTIVES Explore the use of an intra-gastric balloon as an adjunct to a lifestyle support programme, to promote weight loss in severely obese adolescents. Outcomes included weight loss, waist and hip measurements, psychosocial outcomes including health-related quality of life (HRQoL) and physical self perceptions, physical activity and cardiorespiratory fitness. METHOD Non-randomised pilot study. RESULTS Twelve severely obese adolescents (5 males, 7 females; mean age 15 years; BMI >3.5 s.d.; puberty stage 4 or more) and their families were recruited. Mean weight loss at 12 months (n=9) was 3.05 kg±14.69; d=0.002, P=0.550, and a BMI Z-score (n=12) change of 0.2 s.d.; d=0.7, P=0.002 was observed at 6 months with a large effect, but was not sustained at 12 months (mean change 0.1 s.d.; d=0.3, P=0.146). At 24 months (n=10), there was a weight gain from baseline of +9.9 kg±1.21 (d=0.4; P=0.433). Adolescent and parent HRQoL scores exceeded the minimal clinical important difference between baseline and 12 months for all domains but showed some decline at 24 months. CONCLUSION An intra-gastric balloon as an adjunct to a lifestyle support programme represents a safe and well-tolerated treatment approach in severely obese adolescents, with short-term effects on weight change. Improvements in psychosocial health, physical activity and cardiorespiratory fitness were maintained at 12 months, with varying results at 24 months.
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Affiliation(s)
- L J Reece
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - P Sachdev
- Academic Unit of Child Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - R J Copeland
- The National Centre for Sport and Exercise Medicine and The Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - M Thomson
- Department of Gastroenterology, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
| | - J K Wales
- Service Group Director Endocrinology & Nephrology, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia
| | - N P Wright
- Department of Endocrinology, Sheffield Children's Hospital, Sheffield, South Yorkshire, UK
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Koorts H, Gillison F. Mixed method evaluation of a community-based physical activity program using the RE-AIM framework: practical application in a real-world setting. BMC Public Health 2015; 15:1102. [PMID: 26545582 PMCID: PMC4635975 DOI: 10.1186/s12889-015-2466-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Communities are a pivotal setting in which to promote increases in child and adolescent physical activity behaviours. Interventions implemented in these settings require effective evaluation to facilitate translation of findings to wider settings. The aims of this paper are to i) present findings from a RE-AIM evaluation of a community-based physical activity program, and ii) review the methodological challenges faced when applying RE-AIM in practice. METHODS A single mixed-methods case study was conducted based on a concurrent triangulation design. Five sources of data were collected via interviews, questionnaires, archival records, documentation and field notes. Evidence was triangulated within RE-AIM to assess individual and organisational-level program outcomes. RESULTS Inconsistent availability of data and a lack of robust reporting challenged assessment of all five dimensions. Reach, Implementation and setting-level Adoption were less successful, Effectiveness and Maintenance at an individual and organisational level were moderately successful. Only community-level Adoption was highly successful, reflecting the key program goal to provide community-wide participation in sport and physical activity. CONCLUSIONS This research highlighted important methodological constraints associated with the use of RE-AIM in practice settings. Future evaluators wishing to use RE-AIM may benefit from a mixed-method triangulation approach to offset challenges with data availability and reliability.
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Affiliation(s)
- Harriet Koorts
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, VIC, 3125, Australia.
| | - Fiona Gillison
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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Pearson ES, Irwin JD, Burke SM, Shapiro S. Parental perspectives of a 4-week family-based lifestyle intervention for children with obesity. Glob J Health Sci 2012; 5:111-22. [PMID: 23445699 PMCID: PMC4776793 DOI: 10.5539/gjhs.v5n2p111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/11/2012] [Accepted: 11/28/2012] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The childhood obesity epidemic is now recognized as one of the most serious public health challenges of the 21st century. Community-based behaviour modification treatment programs involving both children and their families are warranted. The purpose of this study was to explore the experiences of parents whose children participated in the Children's Health and Activity Modification Program (C.H.A.M.P.): a 4-week lifestyle program delivered as a day-camp for obese children at risk for type II diabetes and their families. Parents were required to attend four half-day education sessions during the intervention period. METHODS Seven focus groups were conducted immediately following the 4-week interventions offered in August 2008 and 2009. The perspectives of 38 parents representing 32 children aged 8-14 with obesity (i.e., body mass index > the 95th percentile) were shared. RESULTS Overall, parents were pleased with the impact of the program and proud of their children's accomplishments (e.g., increased physical activity levels, enhanced self-esteem, weight loss). Several facilitators to success (e.g., social support; a positive environment) and barriers to its maintenance (e.g., time management; unsupportive family members) were identified, and recommendations were made for future programs. Although parents found the half-day sessions valuable, post-programmatic bi-monthly booster session adherence declined over the one-year follow-up period. CONCLUSION Delivered as a 4-week day-camp, C.H.A.M.P. represents a unique approach to the treatment of childhood obesity. Future family-based interventions should consider avenues for intensifying the parental program component whilst employing strategies to promote parental adherence in service of enhancing long-term sustainability of health behaviour changes.
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