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Lim CS, Robinson J, Hinton E, Gordy XZ, Gamble A, Compretta C, Holmes ME, Ravola M. School-based obesity prevention programs in rural communities: a scoping review. JBI Evid Synth 2022; 20:2936-2985. [PMID: 36513382 PMCID: PMC10278058 DOI: 10.11124/jbies-21-00233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature. INTRODUCTION Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities. INCLUSION CRITERIA We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data. METHODS A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives. RESULTS Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations. CONCLUSIONS Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.
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Affiliation(s)
- Crystal S. Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
- Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
| | - Jennifer Robinson
- Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
| | - Elizabeth Hinton
- Mississippi Centre for Evidence Based Practice: A JBI Centre of Excellence, Jackson, MS, USA
- School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA
- Rowland Medical Library, University of Mississippi Medical Center, Jackson, MS, USA
| | - Xiaoshan Z. Gordy
- School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, USA
| | - Abigail Gamble
- School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Caroline Compretta
- Department of Preventive Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Megan E. Holmes
- Department of Kinesiology, Mississippi State University, Starkville, MS, USA
| | - Martha Ravola
- School of Agriculture and Applied Sciences, Alcorn State University, Lorman, MS, USA
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Reschke F, Galuschka L, Landsberg S, Weiner C, Guntermann C, Sadeghian E, Lange K, Danne T. Successful telehealth transformation of a pediatric outpatient obesity teaching program due to the COVID-19 pandemic - the "Video KiCK" program. J Pediatr Endocrinol Metab 2022; 35:803-812. [PMID: 35575788 DOI: 10.1515/jpem-2022-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate if digital approaches can ameliorate the known consequences of social-distancing restrictions in the context of the global COVID-19 pandemic for adolescent participants originally registered for a face-to-face outpatient weight regulation program and whether video-based multiprofessional outpatient obesity therapy is successful for a group of adolescents with preexisting obesity. METHODS The certified KiCK outpatient training program for children and adolescents with overweight and obesity was remodeled as a consequence of the lockdown traditional face-to-face program to a completely digital and video-based format on short notice. The virtual approach was compared with the results of the conventional program regarding metabolic parameters, body mass index standard deviation score (BMI SDS), well-being, and physical fitness. RESULTS Sixty-nine of 77 enrolled participants for KiCK (age 8 to 17 years, BMI z score >2.0) were able and willing to participate virtually. After the first lockdown significant improvements of BMI SDS (mean 0.18; p=0.02), homeostasis model assessment (HOMA) index (mean 1.4; p=0.016), triglycerides (mean 0.18 mmol/dL; p=0.021), 6 minute-walk-test (mean 97.0 m; p=0.030, and well-being according to the World Health Organization 5 (WHO-5) questionnaire (mean 2.5; p=0.002) were found after the virtual intervention, which was comparable to the results observed previously in matched pairs data from the program during the pre-COVID period. After the end of the second lockdown weight SDS, BMI SDS, HOMA INDEX, and cholesterol were also measured reduced compared to baseline parameters measured before program initiation. Walking distance in the 6 MWT and improvement in general well-being in the WHO-5 questionnaire also persisted. CONCLUSIONS These results indicate good acceptance and efficacy of the video-intervention for youth with overweight and obesity during the lockdown, supporting the use of virtual modules in future programs after the pandemic.
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Affiliation(s)
- Felix Reschke
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Laura Galuschka
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Sarah Landsberg
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Chantal Weiner
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Cathrin Guntermann
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Evelin Sadeghian
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
| | - Karin Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Thomas Danne
- KiCK - Initiative, Center for Diabetology and Endocrinology for Children and Adolescents, Children`s Hospital Auf Der Bult, Hannover, Germany
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Wolfenden L, Barnes C, Jones J, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Grady A, Hodder RK, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2020; 2:CD011779. [PMID: 32036618 PMCID: PMC7008062 DOI: 10.1002/14651858.cd011779.pub3] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement evidence-based policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. Examine the cost or cost-effectiveness of such strategies; 2. Examine any adverse effects of such strategies on childcare services, service staff or children; 3. Examine the effect of such strategies on child diet, physical activity or weight status. 4. Describe the acceptability, adoption, penetration, sustainability and appropriateness of such implementation strategies. SEARCH METHODS We searched the following electronic databases on February 22 2019: Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, Embase, PsycINFO, ERIC, CINAHL and SCOPUS for relevant studies. We searched reference lists of included studies, handsearched two international implementation science journals, the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or nonrandomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. Centre-based childcare services included preschools, nurseries, long daycare services and kindergartens catering for children prior to compulsory schooling (typically up to the age of five to six years). DATA COLLECTION AND ANALYSIS Two review authors independently screened study titles and abstracts, extracted study data and assessed risk of bias; we resolved discrepancies via consensus. We performed meta-analysis using a random-effects model where studies with suitable data and homogeneity were identified; otherwise, findings were described narratively. MAIN RESULTS Twenty-one studies, including 16 randomised and five nonrandomised, were included in the review. The studies sought to improve the implementation of policies, practices or programmes targeting healthy eating (six studies), physical activity (three studies) or both healthy eating and physical activity (12 studies). Studies were conducted in the United States (n = 12), Australia (n = 8) and Ireland (n = 1). Collectively, the 21 studies included a total of 1945 childcare services examining a range of implementation strategies including educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing, reminders and tailored interventions. Most studies (n = 19) examined implementation strategies versus usual practice or minimal support control, and two compared alternative implementation strategies. For implementation outcomes, six studies (one RCT) were judged to be at high risk of bias overall. The review findings suggest that implementation strategies probably improve the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention in childcare services. Of the 19 studies that compared a strategy to usual practice or minimal support control, 11 studies (nine RCTs) used score-based measures of implementation (e.g. childcare service nutrition environment score). Nine of these studies were included in pooled analysis, which found an improvement in implementation outcomes (SMD 0.49; 95% CI 0.19 to 0.79; participants = 495; moderate-certainty evidence). Ten studies (seven RCTs) used dichotomous measures of implementation (e.g. proportion of childcare services implementing a policy or specific practice), with seven of these included in pooled analysis (OR 1.83; 95% CI 0.81 to 4.11; participants = 391; low-certainty evidence). Findings suggest that such interventions probably lead to little or no difference in child physical activity (four RCTs; moderate-certainty evidence) or weight status (three RCTs; moderate-certainty evidence), and may lead to little or no difference in child diet (two RCTs; low-certainty evidence). None of the studies reported the cost or cost-effectiveness of the intervention. Three studies assessed the adverse effects of the intervention on childcare service staff, children and parents, with all studies suggesting they have little to no difference in adverse effects (e.g. child injury) between groups (three RCTs; low-certainty evidence). Inconsistent quality of the evidence was identified across review outcomes and study designs, ranging from very low to moderate. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used. AUTHORS' CONCLUSIONS Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status.
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Affiliation(s)
- Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Jannah Jones
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Meghan Finch
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Alice Grady
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
| | - Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Debbie Booth
- University of NewcastleAuchmuty LibraryUniversity DriveCallaghanNSWAustralia2308
| | - Sze Lin Yoong
- University of NewcastleSchool of Medicine and Public HealthCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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Poeta M, Lamberti R, Di Salvio D, Massa G, Torsiello N, Pierri L, Delli Bovi AP, Di Michele L, Guercio Nuzio S, Vajro P. Waist Circumference and Healthy Lifestyle Preferences/Knowledge Monitoring in a Preschool Obesity Prevention Program. Nutrients 2019; 11:E2139. [PMID: 31500234 PMCID: PMC6769722 DOI: 10.3390/nu11092139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 01/28/2023] Open
Abstract
Weight and body mass index (BMI) changes appear to be poor measures for assessing the success of most pediatric obesity prevention programs (POPP). The aim of this study is to evaluate the effectiveness of the preschool-age prevention program (3P) in improving and maintaining overtime preschoolers' knowledge/preferences about healthy nutrition and physical activity (PA), and the relationship between acquired healthy behaviors and anthropometrics including waist circumference (WC). Twenty-five preschoolers underwent a 24-month healthy lifestyle multi-component pilot intervention followed by a one-year wash-out period; 25 age-matched served as controls. Anthropometric/behavioral data were monitored. After the 2-year study and wash-out, the rates of children overweight and with obesity decreased only in the intervention group, where, also, normal-weight children with visceral obesity attained WC normal values (p = 0.048). While mean values of BMI Z-scores remained unchanged in both the intervention and control groups, WC (values and percentiles) showed a significant reduction only in the intervention group. Children's adherence to the Mediterranean diet remained acceptable among the entire sample. Although daily sweet beverage consumption remained unchanged in both groups, knowledge/preferences improved significantly more in the intervention group. In conclusion, WC may be more sensitive than BMI for monitoring preschoolers in POPP and reflects healthy behavioral changes acquired during the intervention.
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Affiliation(s)
- Marco Poeta
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Rossella Lamberti
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Dario Di Salvio
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Grazia Massa
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Nives Torsiello
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Luca Pierri
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Anna Pia Delli Bovi
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Laura Di Michele
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Salvatore Guercio Nuzio
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
| | - Pietro Vajro
- Pediatrics, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Salerno, Italy.
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Kobel S, Wartha O, Lämmle C, Dreyhaupt J, Steinacker JM. Intervention effects of a kindergarten-based health promotion programme on obesity related behavioural outcomes and BMI percentiles. Prev Med Rep 2019; 15:100931. [PMID: 31321204 PMCID: PMC6612931 DOI: 10.1016/j.pmedr.2019.100931] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 06/11/2019] [Accepted: 06/27/2019] [Indexed: 01/22/2023] Open
Abstract
In recent decades, prevalence of childhood overweight has increased worldwide and became a public health concern. One reason is children's insufficient engagement in physical activity (PA) which may lead to deficient motor skills, which are interdependent. Therefore, early health promotion such as the kindergarten-based health promotion programme "Join the Healthy Boat" is necessary. In order to evaluate the programme's effectiveness on children's BMI percentiles (BMIPCT), PA and endurance capacity, a randomised controlled trial including intervention (IG) and control group (CG) was conducted. 973 kindergarten children (3.6 ± 0.6 years; 47.1% male) in 57 kindergartens were assessed at baseline and 558 of them at follow-up. Anthropometrics and endurance capability (3-minute-run) were assessed on site. PA behaviour and socio-economic data were assessed using parental report. Linear regression models were used to determine intervention effects for all health outcomes, adjusting for baseline values, age, gender, BMIPCT and socio-economic variables. After one year, a significant positive intervention effect on children's BMIPCT was found (p ≤ 0.04). Children in the IG spent significantly more days in sufficient PA than children in the CG (3.1 ± 2.1 days vs. 2.5 ± 1.9 days; p ≤ 0.005). Children in the IG performed significantly better in the three minute endurance run than their counterparts in the CG (305.8 ± 46.2 m vs. 286.9 ± 43.2 m; p ≤ 0.001). This teacher-centred health promotion using a low-dose bottom-up approach with action alternatives achieved significant positive effects in the reduction of BMIPCT and significant increases in endurance capacity and daily PA. The programme is therefore ideal for integrating health promotion more intensively into the everyday life of children.
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Affiliation(s)
- Susanne Kobel
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Olivia Wartha
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Christine Lämmle
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jürgen M. Steinacker
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Frauensteige 6, Haus 58/33, D-89075 Ulm, Germany
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Robinson JC, Lim CS, Hinton E, Pintado I, Gamble A, Compretta C, Ravola M. School-based obesity prevention programs in rural communities: a scoping review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1326-1333. [PMID: 31169774 PMCID: PMC7201295 DOI: 10.11124/jbisrir-2017-003957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this scoping review is to map the available literature on school-based obesity prevention programs in rural communities. INTRODUCTION Significant health disparities are associated with childhood obesity, and these disparities disproportionately affect children in disadvantaged communities, such as rural areas. Youth in rural areas are 26% more likely to be obese than youth in urban communities. To combat obesity in children, schools have become an avenue for educating children about the importance of healthy diet and physical activity. Although many school-based obesity prevention programs have been implemented in recent years, more information is needed on programs in rural communities. INCLUSION CRITERIA This scoping review will consider studies that include children 5 to 18 years of age who are enrolled in elementary, middle or high school in a rural setting and that investigate school-based obesity prevention programs. Studies that include children who are in non-rural areas, who are home-schooled, who are in an alternative setting (e.g. juvenile detention) or who are hospitalized will be excluded. Studies published in English since 1990 will be included. METHODS Multiple databases will be searched, including PubMed, CINAHL, ERIC, Embase, Scopus and Academic Search Premier. Trials registers and gray literature will also be searched. After screening the titles and abstracts of identified citations, potentially relevant studies will be retrieved in full. Data will be extracted by independent reviewers and presented in a diagrammatic or tabular form, accompanied by a narrative summary.
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Affiliation(s)
- Jennifer C. Robinson
- School of Nursing, University of Mississippi Medical
Center, Jackson, USA
- Mississippi Centre for Evidence Based Practice: a Joanna
Briggs Institute Centre of Excellence
| | - Crystal S. Lim
- School of Medicine, University of Mississippi Medical
Center, Jackson, USA
- Mississippi Centre for Evidence Based Practice: a Joanna
Briggs Institute Centre of Excellence
| | - Elizabeth Hinton
- School of Nursing, University of Mississippi Medical
Center, Jackson, USA
- Rowland Medical Library, University of Mississippi Medical
Center, Jackson, USA
- Mississippi Centre for Evidence Based Practice: a Joanna
Briggs Institute Centre of Excellence
| | - Irene Pintado
- College of Nursing & Health Sciences, Mississippi
University for Women, Columbus, USA
| | - Abigail Gamble
- School of Population Health, University of Mississippi
Medical Center, Jackson, USA
| | - Caroline Compretta
- School of Medicine, University of Mississippi Medical
Center, Jackson, USA
- Mississippi Centre for Evidence Based Practice: a Joanna
Briggs Institute Centre of Excellence
| | - Martha Ravola
- School of Agriculture and Applied Sciences, Alcorn State
University, Lorman, USA
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