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Shoesmith A, Nathan N, Lum M, Yoong S, Nolan E, Wolfenden L, Shelton RC, Cooper B, Lane C, Grady A, Imad N, Riley-Gibson E, McCarthy N, Pearson N, Hall A. Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C): development and psychometric evaluation of a measure of sustainability determinants in the early childhood education and care setting. Implement Sci 2024; 19:41. [PMID: 38902763 PMCID: PMC11188265 DOI: 10.1186/s13012-024-01372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND There is a need for valid and reliable measures of determinants of sustainability of public health interventions in early childhood education and care (ECEC) settings. This study aimed to develop and evaluate the psychometric and pragmatic properties of such a measure - the Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C). METHODS We undertook a two-phase process guided by the COnsensus-based Standards for the selection of health status Measurement INstruments checklist (COSMIN) and Psychometric and Pragmatic Evidence Rating Scale (PAPERS). Phase 1 involved measure development; i.e., determining items and scales through an iterative process and assessment of face and content validity. Phase 2 involved the evaluation of psychometric and pragmatic properties. The 29-item measure completed by service executives (directors and nominated supervisors) was embedded in a larger survey from a national sample of Australian ECEC services assessing their implementation of nutrition and physical activity programs. Structural validity, concurrent validity, known groups validity, internal consistency, floor and ceiling effects, norms, and pragmatic qualities of the measure were assessed according to the PAPERS criteria. RESULTS The final measure contained 26 items, with respondents reporting how strongly they agreed or disagreed on a five-point Likert scale. Phase 1 assessments confirmed the relevance, and face and content validity of the scale. In Phase 2, we obtained 482 completed surveys, of which 84% (n = 405) completed the entire measure across 405 ECEC settings (one executive per service). Three of the four fit indices for the confirmatory factor analysis met the pre-specified criteria (SRMR = 0.056, CFI = 0.993, RMSEA = 0.067) indicating 'good' structural validity. The IMPRESS-C illustrated: 'good' internal consistency, with Cronbach's alpha values from 0.53 to 0.92; 'emerging' concurrent validity; 'poor' known groups validity; 'good' norms; and 'good' overall pragmatic qualities (cost, readability, length, and assessor burden). CONCLUSIONS The IMPRESS-C possesses strong psychometric and pragmatic qualities for assessing service executive-level perceptions of determinants influencing sustainment of public health interventions within ECEC settings. To achieve a full range of perspectives in this setting, future work should be directed to also develop and test measures of sustainability determinants at the implementer level (e.g., among individual educators and staff).
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Affiliation(s)
- Adam Shoesmith
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Melanie Lum
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Brittany Cooper
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Cassandra Lane
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Noor Imad
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Edward Riley-Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Nicole McCarthy
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Nicole Pearson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
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Vorage L, Vincze L, Tudehope L, Harris N. Effectiveness of Interventions Promoting Dietary Intake, Physical Activity, and Healthy Weight Status of Children in Family Child Care: A Systematic Review. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:242-255. [PMID: 38340129 DOI: 10.1016/j.jneb.2023.12.011] [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: 05/07/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024]
Abstract
INTRODUCTION This systematic review examines the effectiveness of interventions in family child care (FCC) on (1) children's dietary intake, physical activity levels and weight, and (2) FCC health-promoting environments, policies, and practices. Quasi-experimental studies measuring these outcomes were included. METHODS All available articles up to July 2023 were searched using MEDLINE, ERIC, CINAHL, Embase, Scopus, and A+ Education, and 15 interventions were included. Methodological quality was assessed with the Effective Public Health Practice Project Assessment tool. RESULTS Thirteen studies were weak, and 2 strong in quality. Four interventions included children's dietary intake as an outcome measure, 2 included physical activity, and 3 weight status. Twelve interventions assessed nutrition and 7 physical activity environmental outcomes. DISCUSSION Interventions in FCC improved children's dietary intake, but their impact on physical activity and weight status was inconclusive. Furthermore, positive impacts were observed in environmental outcomes related to nutrition, whereas research on physical activity environmental outcomes was limited. IMPLICATIONS FOR RESEARCH AND PRACTICE Future research could replicate interventions to validate effectiveness and understand positive outcome mechanisms. Future interventions might use FCC stakeholders' input, incorporate innovative physical activity components, enhance FCC providers' position as role models, involve parents, and target those groups that are at a high risk of being obese.
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Affiliation(s)
- Lieke Vorage
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
| | - Lisa Vincze
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lucy Tudehope
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Neil Harris
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Grady A, Jackson J, Wolfenden L, Lum M, Milat A, Bauman A, Hodder R, Yoong SL. Assessing the scalability of evidence-based healthy eating and physical activity interventions in early childhood education and care: A cross-sectional study of end-user perspectives. Aust N Z J Public Health 2024; 48:100122. [PMID: 38198903 DOI: 10.1016/j.anzjph.2023.100122] [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] [Received: 05/25/2023] [Revised: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To describe early childhood education and care (ECEC) services: i) perceptions regarding the scalability of healthy eating and physical activity interventions; and ii) associations between scalability and service characteristics. METHODS A cross-sectional survey was conducted with a randomly selected sample of ECEC services across Australia. The scalability of 12 healthy eating and physical activity interventions was assessed using items based on the Intervention Scalability Assessment Tool. Higher scores represented higher perceived scalability. RESULTS From 453 participants, the highest scoring healthy eating and physical activity interventions were 'providing healthy eating education and activities for children' (M43.05) (out of 50) and 'providing sufficient opportunities for child physical activity' (M41.43). The lowest scoring was 'providing families with lunchbox guidelines' (M38.99) and 'engaging families in activities to increase child physical activity' (M38.36). Services located in rural areas, compared to urban areas, scored the overall scalability of both healthy eating and physical activity interventions significantly lower. CONCLUSIONS Perceptions regarding the scalability of healthy eating and physical activity interventions in the ECEC setting vary according to service characteristics. IMPLICATIONS FOR PUBLIC HEALTH Findings identify where government investment and implementation efforts may be prioritised to facilitate scale-up. An investigation into the barriers and support required for lower-scoring interventions is warranted.
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Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; National Centre of Implementation Science, University of Newcastle, NSW, Australia.
| | - Jacklyn Jackson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; National Centre of Implementation Science, University of Newcastle, NSW, Australia
| | - Melanie Lum
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, VIC, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Health, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Rebecca Hodder
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia; National Centre of Implementation Science, University of Newcastle, NSW, Australia
| | - Sze Lin Yoong
- National Centre of Implementation Science, University of Newcastle, NSW, Australia; Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, VIC, Australia
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Al-walah MA, Donnelly M, Heron N. Barriers, enablers and motivators of the "I'm an active Hero" physical activity intervention for preschool children: a qualitative study. Front Pediatr 2024; 12:1333173. [PMID: 38357506 PMCID: PMC10864600 DOI: 10.3389/fped.2024.1333173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 02/16/2024] Open
Abstract
Background Insufficient physical activity (PA) in early childhood is linked to adverse health outcomes and a heightened risk of obesity. Successful PA programmes often require input from key stakeholders, such as parents and educators. However, research on stakeholders' perspectives regarding PA programmes for preschool children is limited, impeding effective programme design and implementation. Objectives This study aims to explore the perspectives of key stakeholders to gain insights into the challenges, facilitators, and motivators that influence the planning, execution, and sustainability of the "I'm an Active Hero (IAAH) intervention component," a preschool-based initiative designed to promote PA among young children. Methods Semi-structured interviews were conducted in Saudi Arabia with individual preschool principals (n = 2), and focus group discussions were held, respectively, with preschool staff members (n = 4, all female) and parents (4 mothers, 5 fathers). Results A thematic analysis identified four main themes: (1) Barriers to parental involvement in preschool PA interventions, such as time constraints, lack of flexibility, limited space, and a shortage of trained staff; (2) Risks and benefits of children's programme participation; (3) Motivators including rewards, non-financial incentives, and concerns about childhood obesity and a sedentary lifestyle; (4) Facilitating factors for overcoming barriers, including staff training, time reallocation, staff coordination, space optimization, non-financial incentives, and sustaining partnerships. Conclusion This study's findings are crucial for childcare professionals, preschools, education authorities, and policymakers, offering valuable insights for future research. However, further collaboration with key stakeholders is essential to enhance individual attitudes and preschool policies for effective intervention implementation.
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Affiliation(s)
- Mosfer A. Al-walah
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Michael Donnelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Neil Heron
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
- School of Medicine, Keele University, Newcastle-Under-Lyme, Staffordshire, England
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Lum M, Grady A, Wolfenden L, Lecathelinais C, Lin Yoong S. Implementation of healthy eating and physical activity practices in Australian early childhood education and care services: A cross-sectional study. Prev Med Rep 2023; 36:102455. [PMID: 37840588 PMCID: PMC10571023 DOI: 10.1016/j.pmedr.2023.102455] [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: 05/29/2023] [Revised: 08/29/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023] Open
Abstract
Background The monitoring of healthy eating and physical activity environments is recommended to support population health. Early childhood education and care (ECEC) services are a key setting to deliver obesity prevention strategies as they reach the majority of children aged under five years and have existing supporting infrastructure. Objectives The aim of this study was to i) describe the prevalence of implementation of evidence-based healthy eating and physical activity practices in an Australian sample of ECEC services, and ii) examine associations between implementation of practices and service characteristics. Methods A random sample of 2,100 centre-based ECEC services across Australia were invited to participate in a cross-sectional survey online or via telephone (August 2021-April 2022). Service characteristics and implementation of 18 evidence-based healthy eating and physical activity practices were assessed. Descriptive statistics and linear mixed regression analyses were performed. Results A total of 1,028 (51.8%) eligible services participated. The healthy eating and physical activity practices with the lowest prevalence of implementation were related to encouraging children to consume age-appropriate beverages (17.9%) and providing families with child physical activity education via workshops or meetings (14.6%), respectively. There was a statistically significant difference in the implementation of healthy eating practices by service characteristics, with long day care services implementing significantly more practices than preschools (p < 0.01). Conclusion There is room to improve the implementation of evidence-based healthy eating and physical activity practices ECEC services. Implementation efforts should be directed towards preschools.
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Affiliation(s)
- Melanie Lum
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong VIC 3220 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW 2287 Australia
- National Centre of Implementation Science, University of Newcastle, Locked Bag 10, Wallsend NSW 2287 Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW 2287 Australia
- National Centre of Implementation Science, University of Newcastle, Locked Bag 10, Wallsend NSW 2287 Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW 2287 Australia
- National Centre of Implementation Science, University of Newcastle, Locked Bag 10, Wallsend NSW 2287 Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW 2287 Australia
| | - Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, School of Health and Social Development, Faculty of Health, Geelong VIC 3220 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend NSW 2287 Australia
- National Centre of Implementation Science, University of Newcastle, Locked Bag 10, Wallsend NSW 2287 Australia
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Neshteruk C, Burkart S, Flanagan EW, Melnick E, Luecking C, Kracht CL. Policy, systems, and environmental interventions addressing physical activity in early childhood education settings: A systematic review. Prev Med 2023; 173:107606. [PMID: 37414226 PMCID: PMC10699121 DOI: 10.1016/j.ypmed.2023.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/30/2023] [Accepted: 07/02/2023] [Indexed: 07/08/2023]
Abstract
Policy, systems, and environmental (PSE) approaches can facilitate physical activity in priority populations (e.g., racial and ethnic minority, low wealth groups) within early childhood education (ECE) settings. The purpose of this review was to 1) characterize the inclusion of priority populations within ECE physical activity interventions containing PSE approaches and 2) identify and describe interventions within these populations. Seven databases were systematically searched (January 2000-Febrary 2022) for ECE-based interventions focusing on children (0-6 years) that utilized at least one PSE approach. Eligible studies included a child physical activity or physical activity environment outcome and child or center-level population characteristics. Forty-four studies, representing 42 interventions were identified. For Aim 1, half of interventions included one PSE approach (21/42), with only 11/42 including three or more approaches. Physical environment changes [e.g., adding play equipment, modifying space (25/42)] were the most used PSE approaches followed by system [e.g., integrating activity into routines, (21/42)] and policy [e.g., outdoor time (20/42)] approaches. Nearly half of interventions were conducted in predominantly priority populations (18/42). Studies were primarily rated as good (51%) or fair (38%) methodological quality using the Downs and Black checklist. In Aim 2, of the 12 interventions assessing child physical activity in priority populations, 9/12 reported at least one physical activity outcome in the expected direction. Of the 11 interventions assessing the physical activity environment, 9/11 reported an effect in the expected direction. Findings indicate clear opportunities exist to target priority populations by incorporating PSE approaches in ECE physical activity interventions.
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Affiliation(s)
- Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States of America.
| | - Sarah Burkart
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America
| | - Emily W Flanagan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, United States of America
| | - Emily Melnick
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States of America
| | - Courtney Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States of America
| | - Chelsea L Kracht
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, United States of America
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Alshammari L, O'Halloran P, McSorley O, Doherty J, Noble H. The effectiveness of foot care educational interventions for people living with diabetes mellitus: An umbrella review. J Tissue Viability 2023:S0965-206X(23)00066-9. [PMID: 37369610 DOI: 10.1016/j.jtv.2023.06.001] [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: 04/10/2023] [Revised: 05/27/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Diabetes Mellitus is a public health problem becoming more prevalent. Diabetic foot is a debilitating condition caused by diabetes mellitus. Diabetic foot, which includes foot ulceration, infection, and destruction of tissues may necessitate amputation. AIM The aim of this review is to derive evidence from existing systematic reviews and meta-analysis on the effectiveness of foot care educational interventions, directly aimed at people living with diabetes. METHODS A systematic search was implemented using biomedical citation databases including Embase, CINAHL, MEDLINE, and PsycINFO. Major repositories of systematic reviews such as the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, and the PROSPERO register were also searched. The search also included a grey literature search and manual searches of reference lists contained within review studies and other relevant published reviews. The umbrella review searched for articles published from January 2016 to 2021 to ensure sources were current and reflected the most recent interventions. RESULTS This umbrella review is the first to collect and summarise the evidence from existing systematic reviews and meta-analyses of foot care educational interventions directly aimed at people living with diabetes. It reports findings from nine systematic reviews on the evaluation of foot care educational interventions. The number of studies included in each review ranged from 6 to 81. A total of 314 primary studies were included. After examining the overlap between studies reported in multiple reviews, 82 were included in the final review. Without providing effective and consistent preventive and prophylactic foot care, creating, and testing interventions, integrating the concept into practice will remain challenging. CONCLUSION Currently, most educational foot care intervention programmes concentrate on a single intervention. However, there is insufficient evidence that a single educational intervention effectively reduces the occurrence of ulcers and amputations or improves patients' knowledge and behaviour. Two studies used complex interventions, and they reduced the incidence amputation and foot ulceration incidence for people living with diabetes.
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Affiliation(s)
- Layla Alshammari
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK; College of Nursing, University of Hail, Hail, 2440, Saudi Arabia.
| | - Peter O'Halloran
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Oonagh McSorley
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Julie Doherty
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Helen Noble
- Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
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Mclaughlin M, Nathan A, Thornton A, Schipperijn J, Trost SG, Christian H. Adaptations to scale-up an early childhood education and care physical activity intervention for real-world availability - Play Active. Int J Behav Nutr Phys Act 2023; 20:65. [PMID: 37264433 DOI: 10.1186/s12966-023-01457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Adaptations for scale-up are ubiquitous but are rarely described in detail. Adaptations may be a key reason for the "scale-up penalty" which is when there is a reduction in intervention effect size following scale-up. The Play Active intervention consists of a physical activity policy for early childhood education and care (ECEC) services, with accompanying implementation support strategies. It was first implemented with 81 ECEC services in Perth, Western Australia, in 2021 - with significant positive changes in physical activity practice uptake. The aim of this paper is to describe the extent, type, fidelity consistency, goals, size, scope, and proposed impact of proposed adaptations to the implementation support strategies for scaling-up Play Active. METHODS Proposed adaptations were defined as planned changes, made prior to making the intervention available. The authors created a list of adaptations from a comparison of the Play Active implementation support strategies, before and after adaptation for proposed statewide availability across Western Australia, Queensland and South Australia, Australia. We used the Framework for Reporting Adaptations and Modifications-Enhanced Implementation Strategies (FRAME-IS) to code adaptations to implementation support strategies. Three authors coded each adaptation and rated their size, scope and proposed impact. RESULTS Fifty-three adaptations to Play Active were identified. Most (68%) were proposed for the 'content' of implementation strategies, including aspects of their delivery. In practice, this involved changing the delivery mode of implementation support strategies from phone call and email support, to website-based delivery. More than half (56%) of adaptations involved 'adding elements' for scale-up. Most adaptations were 'fidelity consistent' (95%). The main goals for adaptations were related to 'increasing the acceptability, appropriateness, or feasibility' (45%), 'decreasing the costs' (19%) and 'increasing adoption of the evidence-based practice' (19%). Adaptations were small to medium in size, with most proposed to have a positive (87%) or neutral (8%) effect on the effectiveness of the intervention, rather than negative (4%). CONCLUSIONS A large number of small, fidelity-consistent, adaptations were proposed for Play Active scale-up. Overall, the process of reporting adaptations was found to be feasible. To understand the impact of these adaptations, it will be important to re-evaluate implementation, effectiveness and process outcomes, at-scale.
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Affiliation(s)
- Matthew Mclaughlin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Andrea Nathan
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Ashleigh Thornton
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Queensland, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
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Adams EK, Nathan A, Trost SG, Schipperijn J, Shilton T, Trapp G, Maitland C, Thornton A, Mclaughlin M, George P, Wenden E, Christian H. Play Active physical activity policy intervention and implementation support in early childhood education and care: results from a pragmatic cluster randomised trial. Int J Behav Nutr Phys Act 2023; 20:46. [PMID: 37081560 PMCID: PMC10118225 DOI: 10.1186/s12966-023-01442-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/17/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Policy interventions to increase physical activity in early childhood education and care (ECEC) services are effective in increasing physical activity among young children. However, a large proportion of ECEC services do not have nor implement a physical activity policy. Play Active is an evidence-informed physical activity policy intervention with implementation support strategies to enable ECEC services to successfully implement their policy. This study examined the effectiveness, implementation, and process outcomes of Play Active. METHODS A pragmatic cluster randomised trial in 81 ECEC services in Perth, Western Australia was conducted in 2021. Services implemented their physical activity policy over a minimum of three months. The effectiveness outcomes were changes in educator practices related to daily time provided for total physical activity and energetic play. Implementation outcomes included changes in director- and educator-reported uptake of policy practices and director-reported uptake of high impact and low effort policy practices. Process evaluation outcomes included awareness, fidelity, reach, and acceptability of the intervention and implementation strategies. Analysis involved descriptive statistics and generalised linear mixed effects models. RESULTS There was a significant increase in the uptake of director-reported policy practices (p = 0.034), but no change in the uptake of the subset of high impact and low effort policy practices. Intervention group educators reported high awareness of the Play Active policy recommendations (90%). Play Active acceptability was high among educators (83%) and directors (78%). Fidelity and reach were high for most implementation support strategies (> 75%). There were no significant changes in the amount of physical activity or energetic play educators provided to children or in the proportion of educators providing the policy recommended ≥ 180 min of physical activity/day or ≥ 30 min of energetic play/day for intervention compared to wait-listed comparison services. CONCLUSIONS Play Active resulted in significantly higher uptake of physical activity practices. However, there was no change in the amount of physical activity provided to children, which may be explained by the relatively short policy implementation period. Importantly, Play Active had high awareness, fidelity, reach, and acceptability. Future research should investigate the effectiveness of Play Active over longer implementation periods and its scalability potential. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (reference number 12620001206910, registered 13/11/2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378304&isReview=true ).
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Affiliation(s)
- Emma K Adams
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia.
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia.
| | - Andrea Nathan
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, 4072, QLD, Australia
| | - Jasper Schipperijn
- Department of Sports Science Clinical Biomechanics, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark
| | - Trevor Shilton
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Georgina Trapp
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Clover Maitland
- School of Human Sciences, The University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, 3004, VIC, Australia
| | - Ashleigh Thornton
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- School of Human Sciences, The University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Matthew Mclaughlin
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Phoebe George
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Elizabeth Wenden
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
| | - Hayley Christian
- Telethon Kids Institute, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
- School of Population and Global Health, University of Western Australia, 35 Stirling Hwy, Perth, 6009, WA, Australia
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