What evidence and support do state-level public health practitioners need to address obesity prevention

Implementation Science Methodologies for Complementary and Integrative Health Research

Published results of efficacy and effectiveness studies on complementary health approaches should lead to widespread uptake of evidence-based practices, but too often, the scientific pathway ends prematurely, before the best ways to improve adoption, implementation, and sustainability can be determined. The National Center for Complementary and Integrative Health (NCCIH) supports the full continuum of the biomedical research pipeline, whereby a complementary health intervention moves from basic and mechanistic research through efficacy trials and through dissemination and implementation. Implementation science has traditionally been thought of as something that only happens after efficacy and effectiveness have been demonstrated, but it can be prudent to evaluate implementation measures earlier in the process. Implementation science assesses more than just barriers and facilitators; it evaluates specific implementation strategies and characterizes the extent that the intervention is modified within the context of the implementation strategy and health care delivery setting. The best choices for implementation science in complementary health interventions depend on the research questions. Implementation science that tests strategies to address implementation at multiple ecologic levels is a high priority to NCCIH.

General practitioners' perceptions of their practice of evidence-based chronic disease prevention interventions: a quantitative study in Shanghai, China

Background

Epidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China.

Method

This cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors.

Result

A total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university.

Conclusions

This study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.

Overcoming Challenges Resulting From COVID-19: New York State's Creating Healthy Schools and Communities Initiative

“Upstream” interventions that increase access or reduce barriers to healthy foods and opportunities for physical activity — referred to as policy, systems, or environmental strategies — are central to encouraging and supporting healthy behaviors that prevent chronic disease at a population level. However, they are complex and challenging to execute, especially during coronavirus disease 2019 (COVID-19), and efforts to build practitioner capacity are warranted. In this commentary, we describe a user or human-centered design (HCD) capacity-building approach to support practitioners in accomplishing the goals of the New York State Creating Healthy Schools and Communities (CHSC) initiative. This approach has been especially helpful during COVID-19, as it enables support to be responsive to practitioners’ constantly changing needs. Given that CHSC is a project specific to New York State and that the efforts of the Obesity Prevention Center for Excellence were tailored to obesity prevention, more research and evaluations should be conducted to better understand how the use of HCD could support practitioners addressing other complex public health issues in the United States.

Developing a Survey Tool to Assess Implementation of Evidence-Based Chronic Disease Prevention in Public Health Settings Across Four Countries

Background: Understanding the contextual factors that influence the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) interventions in public health settings across countries could inform strategies to support the dissemination and implementation of EBCDP interventions globally and more effectively prevent chronic diseases. A survey tool to use across diverse countries is lacking. This study describes the development and reliability testing of a survey tool to assess the stage of dissemination, multi-level contextual factors, and individual and agency characteristics that influence the dissemination and implementation of EBCDP interventions in Australia, Brazil, China, and the United States. Methods: Development of the 26-question survey included, a narrative literature review of extant measures in EBCDP; qualitative interviews with 50 chronic disease prevention practitioners in Australia, Brazil, China, and the United States; review by an expert panel of researchers in EBCDP; and test-retest reliability assessment. Results: A convenience sample of practitioners working in chronic disease prevention in each country completed the survey twice (N = 165). Overall, this tool produced good to moderately reliable responses. Generally, reliability of responses was higher among practitioners from Australia and the United States than China and Brazil. Conclusions: Reliability findings inform the adaptation and further development of this tool. Revisions to four questions are recommended before use in China and revisions to two questions before use in Brazil. This survey tool can contribute toward an improved understanding of the contextual factors that public health practitioners in Australia, Brazil, China, and the United States face in their daily chronic disease prevention work related to the dissemination and implementation of EBCDP interventions. This understanding is necessary for the creation of multi-level strategies and policies that promote evidence-based decision-making and effective prevention of chronic diseases on a more global scale.

Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions

A robust evidence base supports the effectiveness of timely colorectal cancer (CRC) screening, follow-up of abnormal results, and referral to care in reducing CRC morbidity and mortality. However, only two-thirds of the US population is current with recommended screening, and rates are much lower for those who are vulnerable because of their race/ethnicity, insurance status, or rural location. Multiple, multilevel factors contribute to observed disparities, and these factors vary across different populations and contexts. As highlighted by the Cancer Moonshot Blue Ribbon Panel working groups focused on Prevention and Early Detection and Implementation Science inadequate CRC screening and follow-up represent an enormous missed opportunity in cancer prevention and control. To measurably reduce CRC morbidity and mortality, the evidence base must be strengthened to guide the identification of (1) multilevel factors that influence screening across different populations and contexts, (2) multilevel interventions and implementation strategies that will be most effective at targeting those factors, and (3) combinations of strategies that interact synergistically to improve outcomes. Systems thinking and simulation modeling (systems science) provide a set of approaches and techniques to aid decision makers in using the best available data and research evidence to guide implementation planning in the context of such complexity. This commentary summarizes current challenges in CRC prevention and control, discusses the status of the evidence base to guide the selection and implementation of multilevel CRC screening interventions, and describes a multi-institution project to showcase how systems science can be leveraged to optimize selection and implementation of CRC screening interventions in diverse populations and contexts.

A cross-country study of mis-implementation in public health practice

BACKGROUND

Mis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP).

METHODS

A cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue.

RESULTS

We found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program's effectiveness or evidence-base-or lack thereof-were rarely reasons for program continuation and termination.

CONCLUSIONS

Decisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.

Comparing Knowledge, Accessibility, and Use of Evidence-Based Chronic Disease Prevention Processes Across Four Countries

Background: Evidence-based chronic disease prevention (EBCDP) effectively reduces incidence rates of many chronic diseases, but contextual factors influence the implementation of EBCDP worldwide. This study aims to examine the following contextual factors across four countries: knowledge, access, and use of chronic disease prevention processes. Methods: In this cross-sectional study, public health practitioners (N = 400) from Australia (n = 121), Brazil (n = 76), China (n = 102), and the United States (n = 101) completed a 26-question survey on EBCDP. One-way ANOVA and Pearson's Chi-Square tests were used to assess differences in contextual factors of interest by country. Results: Practitioners in China reported less knowledge of EBCDP processes (p < 0.001) and less use of repositories of evidence-based interventions, than those from other countries (p < 0.001). Academic journals were the most frequently used method for accessing information about evidence-based interventions across countries. When selecting interventions, Brazilian and Chinese practitioners were more likely to consider implementation ease while the Australian and United States practitioners were more likely to consider effectiveness (p < 0.001). Conclusions: These findings can help inform and improve within and across country strategies for implementing EBCDP interventions.

A qualitative exploration of contextual factors that influence dissemination and implementation of evidence-based chronic disease prevention across four countries

BACKGROUND

Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.

METHODS

Between February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).

RESULTS

Practitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.

CONCLUSIONS

This study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.

Exploring political influences on evidence-based non-communicable disease prevention across four countries

Implementation of evidence-based practices can improve efficiency and effectiveness of public health efforts. Few studies have explored the political contextual factors that impact implementation of evidence-based non-communicable disease prevention (EBNCDP). This study aimed to do so in Australia, Brazil, China and the United States. Investigators conducted 10-13 qualitative, semi-structured interviews of public health practitioners working in functionally similar public health organizations in each country (total N = 50). Study participants were identified through purposive sampling and interviews were structured around an interview guide covering six domains related to EBNCDP. Interviewees from all four countries identified funding as the primary politically-influenced barrier to implementing EBNCDP. Similarly widespread barriers included government funding priorities that shift based on who is in power and the difficulty of convincing policy-makers and funders that non-communicable disease prevention is a wise investment of political capital. Policymakers who are not evidence-driven was another common barrier even in the United States and Australia, where EBNCDP is more established. Findings suggest that political contextual factors influence EBNCDP and vary to an extent by country, though certain factors seem to be universal. This can aid public health practitioners, political leaders, and policymakers in advocating for conditions and policies that encourage evidence-based practice.

School health implementation tools: a mixed methods evaluation of factors influencing their use

Background

The U.S. Centers for Disease Control and Prevention (CDC) develops tools to support implementation of evidence-based interventions for school health. To advance understanding of factors influencing the use of these implementation tools, we conducted an evaluation of state, school district, and local school staffs’ use of four CDC tools to support implementation of physical activity, nutrition, health education, and parent engagement. Two frameworks guided the evaluation: Interactive Systems Framework (ISF) for Dissemination and Implementation and Consolidated Framework for Implementation Research (CFIR).

Methods

The evaluation applied a mixed methods, cross-sectional design that included online surveys (n = 69 state staff from 43 states), phone interviews (n = 13 state staff from 6 states), and in-person interviews (n = 90 district and school staff from 8 districts in 5 states). Descriptive analyses were applied to surveys and content analysis to interviews.

Results

The survey found that the majority of state staff surveyed was aware of three of the CDC tools but most were knowledgeable and confident in their ability to use only two. These same two tools were the ones for which states were most likely to have provided training and technical assistance in the past year. Interviews provided insight into how tools were used and why use varied, with themes organized within the ISF domain “support strategies” (e.g., training, technical assistance) and four CFIR domains: (1) characteristics of tools, (2) inner setting, (3) outer setting, and (4) individuals. Overall, tools were valued for the credibility of their source (CDC) and evidence strength and quality. Respondents reported that tools were too complex for use by school staff. However, if tools were adaptable and compatible with inner and outer setting factors, state and district staff were willing and able to adapt tools for school use.

Conclusions

Implementation tools are essential to supporting broad-scale implementation of evidence-based interventions. This study illustrates how CFIR and ISF might be applied to evaluate factors influencing tools’ use and provides recommendations for designing tools to fit within the multi-tiered systems involved in promoting, supporting, and implementing evidence-based interventions in schools. Findings have relevance for the design of implementation tools for use by other multi-tiered systems.

Using Obesity Research to Shape Obesity Policy in Minnesota: Stakeholder Insights and Feasibility of Recommendations

OBJECTIVE

Preventing childhood obesity requires innovative, evidence-based policy approaches. This study examines the use of research evidence by obesity policy stakeholders in Minnesota and develops pilot tools for communicating timely evidence to policymakers.

DESIGN, SETTING, AND PARTICIPANTS

From November 2012 to January 2013, semistructured interviews were conducted with 51 Minnesota stakeholders in childhood obesity prevention. Interviewees included 16 state legislators and staff; 16 personnel from the Minnesota Department of Education, Minnesota Department of Health, and Minnesota Department of Transportation; and 19 advocates for and against childhood obesity prevention legislation (response rate = 71%).

MAIN OUTCOME MEASURES

Participants were asked their views on 3 themes: (1) Whether and how they used research evidence in their current decision-making processes; (2) barriers to using research evidence for policymaking; and (3) suggestions for improving the evidence translation process. All interviews were audio-recorded and transcribed. A team approach to qualitative analysis was used to summarize themes, compare findings across interviewees' professional roles, and highlight unexpected findings, areas of tension, or illuminating quotes.

RESULTS

Stakeholders used research evidence to support policy decisions, educate the public, and overcome value-based arguments. Common challenges included the amount and complexity of research produced and limited relationships between researchers and decision makers. Responding to interviewee recommendations, we developed and assessed 2 pilot tools: a directory of research experts and a series of research webinars on topics related to childhood obesity. Stakeholders found these materials relevant and high-quality but expressed uncertainty about using them in making policy decisions.

CONCLUSIONS

Stakeholders believe that research evidence should inform the design of programs and policies for childhood obesity prevention; however, many lack the time and resources to consult research consistently. Future efforts to facilitate evidence-informed policymaking should emphasize approaches to designing and presenting research that better meets the needs of policy and programmatic decision makers.

Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale

The US tobacco industry spends $8.2 billion annually on marketing at the point of sale (POS), a practice known to increase tobacco use. Evidence-based policy interventions (EBPIs) are available to reduce exposure to POS marketing, and nationwide, states are funding community-based tobacco control partnerships to promote local enactment of these EBPIs. Little is known, however, about what implementation strategies best support community partnerships' success enacting EBPI. Guided by Kingdon's theory of policy change, Counter Tools provides tools, training, and other implementation strategies to support community partnerships' performance of five core policy change processes: document local problem, formulate policy solutions, engage partners, raise awareness of problems and solutions, and persuade decision makers to enact new policy. We assessed Counter Tools' impact at 1 year on (1) partnership coordinators' self-efficacy, (2) partnerships' performance of core policy change processes, (3) community progress toward EBPI enactment, and (4) salient contextual factors. Counter Tools provided implementation strategies to 30 partnerships. Data on self-efficacy were collected using a pre-post survey. Structured interviews assessed performance of core policy change processes. Data also were collected on progress toward EBPI enactment and contextual factors. Analysis included descriptive and bivariate statistics and content analysis. Following 1-year exposure to implementation strategies, coordinators' self-efficacy increased significantly. Partnerships completed the greatest proportion of activities within the "engage partners" and "document local problem" core processes. Communities made only limited progress toward policy enactment. Findings can inform delivery of implementation strategies and tests of their effects on community-level efforts to enact EBPIs.

Implementation of national guidelines for the prevention and treatment of overweight and obesity in children and adolescents: a phenomenographic analysis of public health nurses' perceptions

Objective

To explore and describe how public health nurses (PHNs) perceive the implementation of national guidelines for the prevention and treatment of overweight and obesity among children and adolescents in well-baby clinics and school health services.

Design, sample, and measurements

An explorative descriptive design was carried out through individual interviews with 18 PHNs and analysed according to the phenomenographic tradition.

Results

Four implementation strategies were described and assigned a metaphor: the structured PHN, pragmatic PHN, critical PHN, and the resigned PHN. Competence, patient receptiveness, internal consensus, interdisciplinary collaboration, resources, and organizational embedding were the determinants identified that most frequently affect implementation, and these determinants were distributed at different levels of the organization. The extent of facilitation seemed to determine which implementation strategy would be used.

Conclusions

How PHNs implemented the guidelines for overweight and obesity were affected by determinants at different organizational levels. Contextual facilitation of implementation seemed better in larger organizations, but factors such as leadership, drive, and experience compensated in smaller municipalities. The implementation of guidelines was hindered when the barriers exceeded the benefits.

Developing a Tool to Assess the Capacity of Out-of-School Time Program Providers to Implement Policy, Systems, and Environmental Change

BACKGROUND

Little is known about public health practitioners' capacity to change policies, systems, or environments (PSEs), in part due to the absence of measures. To address this need, we partnered with the Alliance for a Healthier Generation (Alliance) to develop and test a theory-derived measure of the capacity of out-of-school time program providers to improve students' level of nutrition and physical activity through changes in PSEs.

COMMUNITY CONTEXT

The measure was developed and tested through an engaged partnership with staff working on the Alliance's Healthy Out-of-School Time (HOST) Initiative. In total, approximately 2,000 sites nationwide are engaged in the HOST Initiative, which serves predominantly high-need children and youths.

METHODS

We partnered with the Alliance to conduct formative work that would help develop a survey that assessed attitudes/beliefs, social norms, external resources/supports, and self-efficacy. The survey was administered to providers of out-of-school time programs who were implementing the Alliance's HOST Initiative.

OUTCOME

Survey respondents were 185 out-of-school time program providers (53% response rate). Exploratory factor analysis yielded a 4-factor model that explained 44.7% of the variance. Factors pertained to perceptions of social norms (6 items) and self-efficacy to build support and engage a team (4 items) and create (5 items) and implement (3 items) an action plan.

INTERPRETATION

We report initial development and factor analysis of a tool that the Alliance can use to assess the capacity of after-school time program providers, which is critical to targeting capacity-building interventions and assessing their effectiveness. Study findings also will inform the development of measures to assess individual capacity to plan and implement other PSE interventions.

Policy, Systems, and Environmental Approaches to Obesity Prevention: Translating and Disseminating Evidence from Practice

To reduce obesity prevalence, public health practitioners are intervening to change health behaviors as well as the policies, systems, and environments (PSEs) that support healthy behaviors. Although the number of recommended PSE intervention strategies continues to grow, limited guidance is available on how to implement those strategies in practice. This article describes the University of North Carolina at Chapel Hill, Center for Training and Research Translation's (Center TRT's) approach to reviewing, translating, and disseminating practitioner-developed interventions, with the goal of providing more practical guidance on how to implement PSE intervention strategies in real-world practice. As of August 2014, Center TRT had disseminated 30 practice-based PSE interventions. This article provides an overview of Center TRT's process for reviewing, translating, and disseminating practice-based interventions and offers key lessons learned during the nine years that Center TRT has engaged in this work.

Evaluating Policy, Systems, and Environmental Change Interventions: Lessons Learned From CDC's Prevention Research Centers

Introduction

The field of public health is increasingly implementing initiatives intended to make policies, systems, and environments (PSEs) more supportive of healthy behaviors, even though the evidence for many of these strategies is only emerging. Our objective was 3-fold: 1) to describe evaluations of PSE-change programs in which the evaluators followed the steps of the Centers for Disease Control and Prevention’s (CDC’s) Framework for Program Evaluation in Public Health, 2) to share the resulting lessons learned, and 3) to assist future evaluators of PSE-change programs with their evaluation design decisions.

Methods

Seven Prevention Research Centers (PRCs) applied CDC’s framework to evaluate their own PSE-change initiatives. The PRCs followed each step of the framework: 1) engage stakeholders, 2) describe program, 3) focus evaluation design, 4) gather credible evidence, 5) justify conclusions, and 6) ensure use and share lessons learned.

Results

Evaluation stakeholders represented a range of sectors, including public health departments, partner organizations, and community members. Public health departments were the primary stakeholders for 4 of the 7 evaluations. Four PRCs used logic models to describe the initiatives being evaluated. Their evaluations typically included both process and outcome questions and used mixed methods. Evaluation findings most commonly focused on contextual factors influencing change (process) and the adoption or implementation of PSE-change strategies (outcome). Evaluators shared lessons learned through various channels to reach local stakeholders and broader public health audiences.

Conclusion

Framework for Program Evaluation in Public Health is applicable to evaluations of PSE-change initiatives. Using this framework to guide such evaluations builds practice-based evidence for strategies that are increasingly being used to promote healthful behaviors.

Synthesizing Marketing, Community Engagement, and Systems Science Approaches for Advancing Translational Research

The adoption and implementation of evidence-based interventions (EBIs) are the goals of translational research; however, potential end-users' perceptions of an EBI value have contributed to low rates of adoption. In this article, we describe our application of emerging dissemination and implementation science theoretical perspectives, community engagement, and systems science principles to develop a novel EBI dissemination approach. Using consumer-driven, graphics-rich simulation, the approach demonstrates predicted implementation effects on health and employment outcomes for socioeconomically disadvantaged women at the local level and is designed to increase adoption interest of county program managers accountable for improving these outcomes in their communities.

Disseminating policy and environmental change interventions: insights from obesity prevention and tobacco control

BACKGROUND

Public health and other practitioners increasingly are being asked to implement policy and environmental change interventions, yet many practitioners lack the knowledge, skills, and resources to do so. In response to this need, a growing number of organizations are disseminating evidence-based interventions (EBIs) and building practitioners' capacity to use those interventions in practice. Although advances have been made on approaches to disseminating individual-level EBIs, little is known about the optimal way to disseminate EBIs to promote policy and environmental change.

PURPOSE

This paper describes the approach that two projects developed to disseminate policy and environmental change interventions. The Center for Training and Research Translation (Center TRT) disseminates EBIs to promote physical activity and healthy eating. Counter Tobacco disseminates EBIs to counter tobacco product sales and marketing in the retail environment.

METHOD

Both Centers (1) identify the best available evidence, (2) disseminate menus of intervention strategies, (3) provide implementation guidance, (4) incorporate stories from the field, (5) build practitioners' capacity, and (6) integrate dissemination into practitioners' existing social networks. The Centers' process evaluations included website analytics and online surveys.

RESULT

Over 26,000 unique visitors accessed the Center TRT website in 2012 and over 17,000 have accessed Counter Tobacco's site since its launch in August 2011. The majority of respondents to Centers' surveys agreed that resources were easy to access and use.

CONCLUSION

Both Centers have had success reaching their intended audiences. Research is now needed to assess the extent of practitioners' use of Center resources and the impact of the resulting interventions.

Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013

INTRODUCTION

Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings.

METHODS

The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the "COCOMO" strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus.

RESULTS

Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships.

CONCLUSIONS

Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.

The cancer prevention and control research network: An interactive systems approach to advancing cancer control implementation research and practice

BACKGROUND

Although cancer research has advanced at a rapid pace, a gap remains between what is known about how to improve cancer prevention and control (CPC) and what is implemented as best practices within health care systems and communities. The Cancer Prevention and Control Research Network (CPCRN), with more than 10 years of dissemination and implementation research experience, aims to accelerate the uptake and use of evidence-based CPC interventions.

METHODS

The collective work of the CPCRN has facilitated the analysis and categorization of research and implementation efforts according to the Interactive Systems Framework for Dissemination and Implementation (ISF), providing a useful heuristic for bridging the gap between prevention research and practice. The ISF authors have called for examples of its application as input to help refine the model.

RESULTS

We provide examples of how the collaborative activities supported by the CPCRN, using community-engaged processes, accelerated the synthesis and translation of evidence, built both general and innovation-specific capacity, and worked with delivery systems to advance cancer control research and practice.

CONCLUSIONS

The work of the CPCRN has provided real-world examples of the application of the ISF and demonstrated that synthesizing and translating evidence can increase the potential that evidence-based CPC programs will be used and that capacity building for both the support system and the delivery system is crucial for the successful implementation and maintenance of evidence-based cancer control.

IMPACT

Adoption and implementation of CPC can be enhanced by better understanding ISF systems and intervening to improve them.