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Butscher F, Ellinger J, Singer M, Mall C. Influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low socioeconomic status: a systematic review. Implement Sci Commun 2024; 5:12. [PMID: 38347649 PMCID: PMC10860312 DOI: 10.1186/s43058-024-00548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Health inequity (HI) remains a major challenge in public health. Improving the health of children with low socioeconomic status (SES) can help to reduce overall HI in children. Childhood obesity is a global problem, entailing several adverse health effects. It is crucial to assess the influencing factors for adoption, implementation, and sustainment of interventions. This review aims to identify articles reporting about influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low SES. It aims to critically appraise the articles' quality, assess influencing factors, categorize and evaluate them, and to discuss possible implications. METHODS A systematic search was conducted in 7 databases with the following main inclusion criteria: (1) school-based interventions and (2) target group aged 5-14 years. The Consolidated Framework for Implementation Research, its five domains (intervention characteristics, inner setting, outer setting, characteristics of individuals, process) along with 39 categories within these domains were used as deductive category system for data analysis. We grouped the articles with regard to the characteristics of the interventions in simple and complex interventions. For each domain, and for the groups of simple and complex interventions, the most commonly reported influencing factors are identified. RESULTS In total, 8111 articles were screened, and 17 met all eligibility criteria. Included articles applied mixed methods (n=11), qualitative (n=5), and quantitative design (n=1). Of these, six were considered to report simple interventions and eleven were considered to report complex interventions. In total, 301 influencing factors were assessed. Aspects of the inner setting were reported in every study, aspects of the outer setting were the least reported domain. In the inner setting, most reported influencing factors were time (n=8), scheduling (n=6), and communication (n=6). CONCLUSION This review found a wide range of influencing factors for implementation and contributes to existing literature regarding health equity as well as implementation science. Including all stakeholders involved in the implementation process and assessing the most important influencing factors in the specific setting, could enhance implementation and intervention effectiveness. More empirical research and practical guidance are needed to promote obesity prevention behaviors among children with low SES. REGISTRATION CRD42021281209 (PROSPERO).
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Affiliation(s)
- Friederike Butscher
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Jan Ellinger
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Monika Singer
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Christoph Mall
- TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
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McCrossan E, Fornaro EG, Servello S, Hawes P, Erdem E, Struloeff K. "A Growing Relationship": Cultivating Organizational Readiness to Influence Implementation of Policy, Systems, and Environmental (PSE) Change Programming in SNAP-Ed Funded School-Community Partnerships. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:394-403. [PMID: 37074256 DOI: 10.1016/j.jneb.2023.03.003] [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: 02/23/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Provide a nuanced understanding of how Supplemental Nutrition Assistance Program-Education (SNAP-Ed) implementers decide what programming a school is ready to implement and the organizational factors that facilitate the initial implementation of programming in schools. DESIGN Case studies conducted at schools during 2018-19. SETTING Nineteen School District of Philadelphia schools receiving nutrition programming funded by SNAP-Ed. PARTICIPANTS Interviews were conducted with 119 school staff and SNAP-Ed implementers. A total of 138 hours of observations of SNAP-Ed programming were completed. PHENOMENON OF INTEREST How do SNAP-Ed implementers decide what PSE programming a school is ready to implement? What organizational factors can be developed to facilitate the initial implementation of PSE programming in schools? ANALYSIS Interview transcripts and observation notes were coded deductively and inductively on the basis of theories of organizational readiness for programming implementation. RESULTS Supplemental Nutrition Assistance Program-Education implementers focused on schools' existing capacity when determining readiness for programming. CONCLUSIONS AND IMPLICATIONS Findings suggest that if SNAP-Ed implementers only focus on a school's existing capacity when assessing its readiness for programming, the school might not receive the programming it needs. Findings suggest SNAP-Ed implementers could develop a school's readiness for programming by concentrating efforts on cultivating relationships, program-specific capacity, and motivation at schools. Findings have equity implications for partnerships in underresourced schools that may have limited existing capacity and consequentially could be denied vital programming.
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Affiliation(s)
- Erin McCrossan
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA.
| | - Elisabeth G Fornaro
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Soula Servello
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Peter Hawes
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Ebru Erdem
- Office of Research and Evaluation, the School District of Philadelphia, Philadelphia, PA
| | - Katrina Struloeff
- Catalyst @ Penn GSE, University of Pennsylvania Graduate School of Education, Philadelphia, PA
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Hasson RE, Eisman AB, Wassmann A, Beemer LR, Templin T, Malinoff L, Zernicke R, Rabaut L. Aligning Organizational Priorities and System Policies to Support Implementation Scale-Up of a Tailored Classroom-Based Physical Activity Intervention in Low-Resource Schools. THE JOURNAL OF SCHOOL HEALTH 2023; 93:464-474. [PMID: 36918350 PMCID: PMC10276353 DOI: 10.1111/josh.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND A mismatch between organizational priorities and system-level policies can negatively impact implementation and sustainment of classroom-based physical activity (PA) interventions. The purpose of this study was twofold: (1) present methods to systematically identify organization- and system-level implementation barriers, and (2) align organizational priorities and system policies by designing multi-level implementation strategies. This alignment will support implementation scale-up of a tailored PA intervention in one low-resource intermediate school district (ISD; 16 districts, 32 schools) in central Michigan. METHODS Multi-level assessments of organizational readiness were conducted using the Hexagon Discussion and Analysis Tool to assess intervention-context fit, the Wellness School Assessment Tool 3.0 to evaluate district PA policy strength and comprehensiveness, and semi-structured interviews were conducted to assess administrative support and priorities related to PA programming. RESULTS Our assessments revealed three implementation barriers: limited structural capacity to sustain teacher training, limited resources across districts and school buildings to support teachers, and misalignment of ISD and district PA policies and priorities. CONCLUSIONS Greater attention to organizational capacity and existing infrastructure should be considered a priori to support effective implementation and sustainment of PA interventions in low-resource schools.
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Affiliation(s)
- Rebecca E Hasson
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109; University of Michigan Exercise & Sports Science Initiative, Ann Arbor, MI 48109
| | - Andria B Eisman
- Wayne State University College of Education, Detroit, MI 48202; Wayne State Center for Health and Community Impact, Detroit, MI 48202
| | - Amy Wassmann
- Saginaw Intermediate School District, Saginaw, MI 48603
| | - Lexie R Beemer
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109
| | - Thomas Templin
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109
| | | | - Ronald Zernicke
- University of Michigan School of Kinesiology, Ann Arbor, MI 48109; University of Michigan Exercise & Sports Science Initiative, Ann Arbor, MI 48109
| | - Lisa Rabaut
- University of Michigan Exercise & Sports Science Initiative, Ann Arbor, MI 48109
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Imad N, Pearson N, Hall A, Shoesmith A, Nathan N, Giles L, Grady A, Yoong S. A Pilot Randomised Controlled Trial to Increase the Sustainment of an Indoor-Outdoor-Free-Play Program in Early Childhood Education and Care Services: A Study Protocol for the Sustaining Play, Sustaining Health (SPSH) Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5043. [PMID: 36981955 PMCID: PMC10048850 DOI: 10.3390/ijerph20065043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Early Childhood Education and Care (ECEC) settings are important environments to support children's physical activity (PA). In 2021, COVID-19 regulations recommended the provision of indoor-outdoor free-play programs in ECEC settings to reduce the transmission of COVID-19, resulting in an increased uptake of this practice. As the context has since changed, research suggests that ECEC services could cease the implementation of these practices. Therefore, this pilot randomised controlled trial (RCT) aims to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure the ongoing implementation (sustainment) of ECEC-delivered indoor-outdoor free-play programs. Twenty ECEC services located in New South Wales, Australia that have implemented indoor-outdoor free-play programs since the release of COVID-19 guidelines will be recruited. The services will be randomly allocated either the sustainment strategy or usual care. The "Sustaining Play, Sustaining Health" program consists of eight strategies, developed to address key barriers against and facilitators of sustainment informed by the Integrated Sustainability Framework. The outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of free play. This study will provide important data to support the performance of a fully powered trial within Australian ECEC settings and to inform the development of future sustainment strategies.
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Affiliation(s)
- Noor Imad
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC 3122, 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
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Luke Giles
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
| | - Alice Grady
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Serene Yoong
- 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
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW 2308, Australia
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Ismail MR, Gilliland JA, Matthews JI, Battram DS. Process evaluation of the Centrally Procured School Food Program (CPSFP) in Ontario, Canada: school-level perspectives. HEALTH EDUCATION RESEARCH 2022; 36:554-567. [PMID: 34191009 DOI: 10.1093/her/cyab023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 04/19/2021] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
This study explored the implementation of the Centrally Procured School Food Program (CPSFP)-a free, universal, volunteer-led snack program for elementary school children. To assess participants' perceptions and experiences with the CPSFP, interviews were conducted in school-level participants (n = 33) using a semi-structured interview guide. Fifteen on-site visits also were conducted at each school to observe implementation practices. Quantitative data were obtained through a general information form where participants provided school characteristics and weekly logbooks where they described program operations and food quality. Most participants expressed positive perceptions of the CPSFP, identifying it as a valuable program for their students. Successful program implementation was associated with an appreciation for the CPSFP and the participation of the school community. Challenges to program implementation included concerns with the volume and types of food provided, issues with classroom food delivery and distribution and communication challenges. Suggestions for improvement included building capacities and enhancing student engagement in the program. Participants provided an in-depth assessment of the implementation of the CPSFP. The lessons learned and suggestions provided may help not only enhance the reach, feasibility and fidelity of the CPSFP, but inform the best practices for similar programs.
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Zhao X, Lee RE, Ledoux TA, Hoelscher DM, McKenzie TL, O'Connor DP. Harmonizing Ratings From Different School Environment Assessment Methods: A Simplified Approach. THE JOURNAL OF SCHOOL HEALTH 2022; 92:92-98. [PMID: 34796495 DOI: 10.1111/josh.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND This study describes a method for harmonizing data collected with different tools to compute a rating of compliance with national recommendations for school physical activity (PA) and nutrition environments. METHODS We reviewed questionnaire items from 84 elementary schools that participated in the Childhood Obesity Research Demonstration (CORD) project, which was 3 distinct childhood obesity prevention projects in 7 communities in California, Massachusetts, and Texas. Each project used tools specific to its programs, schools, and communities. While this approach increased the feasibility of data collection, it created a challenge with the need to combine data across projects. We evaluated all questionnaire items and retained only those items that assessed one or more recommendations and constructed several items to indicate compliance or noncompliance with the respective associated recommendations. RESULTS Ten constructed items covered 11 of the 20 recommendations. Analysis indicated that the scores detected variability in compliance both among communities and among school within communities. CONCLUSIONS The scores captured differences in compliance with the national recommendations at multiple levels. Our method, designed for creating common scores, may be useful in integrated data analysis, systematic reviews, or future studies requiring harmonizing of data collected via different tools.
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Affiliation(s)
- Xue Zhao
- Department of Health and Human Performance, University of Houston, 3875 Holman Street GAR 104, 77204-6015, Houston, TX, USA
| | - Rebecca E Lee
- College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, 85004, Phoenix, AZ, USA
| | - Tracey A Ledoux
- Department of Health and Human Performance, University of Houston, 3875 Holman St., Rm 104 Garrison, 77204-6015, Houston, TX, USA
| | - Deanna M Hoelscher
- School of Public Health, Health Science Center at Houston (UTHealth), The University of Texas, 1616 Guadalupe Street, Suite 6.300, 78701, Austin, TX, USA
| | - Thomas L McKenzie
- School of Exercise and Nutritional Sciences, San Diego State University, 5127 Walsh Way, 92115, San Diego, CA, USA
| | - Daniel P O'Connor
- Department of Health and Human Performance, HEALTH Research Institute, University of Houston, 3875 Holman St., Rm 104 Garrison, 77204-6015, Houston, TX, USA
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Essay AM, Schlechter CR, Mershon CA, Fial AV, Ellison J, Rosenkranz RR, Dzewaltowski DA. A scoping review of whole-of-community interventions on six modifiable cancer prevention risk factors in youth: A systems typology. Prev Med 2021; 153:106769. [PMID: 34416222 DOI: 10.1016/j.ypmed.2021.106769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 12/28/2022]
Abstract
Whole-of-community interventions delivered across entire geospatial areas show promise for improving population health for youth cancer prevention. The aims of this scoping review were to synthesize the whole-of-community intervention literature on six modifiable risk factors in youth for cancer prevention (alcohol use, diet, obesity, physical activity, sun exposure, tobacco use) and to develop and apply a typology describing the inclusion of fundamental control system functional characteristics. A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus for studies published to the end of 2019. Eligible studies included a geospatially defined whole-of-community intervention; youth 0-18 years; and at least one of the six cancer risk factor outcomes. An iterative process was undertaken to create a typology describing the functions for whole-of-community interventions guided by systems theory, and the typology was used to code the included interventions. A total of 41 interventions were included. Most interventions (43.9%) assessed multiple cancer risk factors. Few interventions provided fundamental functions necessary for community system coordination: sensor, controller, effector. Although communities are a patchwork quilt of microsystems where individuals interact in geographically bounded places nested within larger whole systems of influence, a control systems approach has not been used to frame the literature. Whole-of-community interventions can be characterized by the fundamental system functions necessary for coordinating population health improvement. Future whole-of-community intervention efforts should draw on fundamental knowledge of how systems operate and test whether adoption of the key functions is necessary for whole-of-community population health improvement.
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Affiliation(s)
- Ann M Essay
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
| | - Chelsey R Schlechter
- Department of Population Health Sciences, Huntsman Cancer Institute, Center for Health Outcomes and Population Equity (HOPE), University of Utah, 2000 Cir of Hope Dr, Salt Lake City, UT 84112, USA.
| | - Carrie A Mershon
- Department of Kinesiology, Kansas State University, Natatorium 8, 920 Denison Ave, Manhattan, KS 66506, USA.
| | - Alissa V Fial
- Raynor Memorial Libraries, Marquette University, 1355 W Wisconsin Ave, Milwaukee, WI 53233, USA.
| | - Jennie Ellison
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA
| | - Richard R Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, 245 Justin Hall, 1324 Lovers Lane, Manhattan, KS 66506, USA.
| | - David A Dzewaltowski
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365, USA.
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Using system thinking methodologies to address health care complexities and evidence implementation. JBI Evid Implement 2021; 20:3-9. [PMID: 34845166 DOI: 10.1097/xeb.0000000000000303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite health care advances, artificial intelligence and government interventions aiming to improve the health and wellbeing of citizens, huge disparities and failures in care provision exist. This is demonstrated by the rising number of medical errors, increase in readmission rates and mortality rates, and the failure of many health systems to successfully cope with events, such as pandemics and natural disasters. This shortfall is in part because of the complexity of the health care system, the interconnectedness of various parts of service, funding models, the complexity of patients' conditions, patient and carer needs, and the clinical processes needed for patients via multiple providers. OBJECTIVE The objective of this paper is to describe the use of system thinking methodologies to address complex problems such as those in the public health and health services domains. METHOD A description of the system thinking methodology and its associated methods including causal loop diagrams, social network analysis and soft system methodology are described with examples in the health care setting. RESULTS There are various models of knowledge translation that have been employed including the Joanna Briggs Institute model of implementation of evidence into practice, the triple C, and the Promoting Action on Research Implementation in Health Services. However, many of these models are neither scalable nor sustainable, and are most effective for localized projects implemented by trained clinicians and champions in relevant settings.System thinking is essentially a modelling process, which aims to create opportunities for change via an appreciation of perspective, and recognition that complex problems are a result of interconnected factors. The article argues that systems thinking applications need to move beyond that of addressing complex health issues pertaining to a population, and rather consider complex problems surrounding the delivery of high-quality health care. CONCLUSION It is important that methods to implement systems thinking methodologies in health care settings are developed and tested.
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Bryant M, Burton W, Collinson M, Farrin A, Nixon J, Stevens J, Roberts K, Foy R, Rutter H, Copsey B, Hartley S, Tubeuf S, Brown J. A cluster RCT and process evaluation of an implementation optimisation intervention to promote parental engagement enrolment and attendance in a childhood obesity prevention programme: results of the Optimising Family Engagement in HENRY (OFTEN) trial. Trials 2021; 22:773. [PMID: 34740373 PMCID: PMC8569980 DOI: 10.1186/s13063-021-05757-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Poor and variable implementation of childhood obesity prevention programmes reduces their population impact and sustainability. We drew upon ethnographic work to develop a multi-level, theory-based implementation optimisation intervention. This intervention aimed to promote parental enrolment and attendance at HENRY (Health Exercise Nutrition for the Really Young), a UK community obesity prevention programme, by changing behaviours of children’s centre and local authority stakeholders. Methods We evaluated the effectiveness of the implementation optimisation intervention on HENRY programme enrolment and attendance over a 12-month implementation period in a cluster randomised controlled trial. We randomised 20 local government authorities (with 126 children’s centres) to HENRY plus the implementation optimisation intervention or to HENRY alone. Primary outcomes were (1) the proportion of centres enrolling at least eight parents per programme and (2) the proportion of centres with a minimum of 75% of parents attending at least five of eight sessions per programme. Trial analyses adjusted for stratification factors (pre-randomisation implementation of HENRY, local authority size, deprivation) and allowed for cluster design. A parallel mixed-methods process evaluation used qualitative interviews and routine monitoring to explain trial results. Results Neither primary outcome differed significantly between groups; 17.8% of intervention centres and 18.0% of control centres achieved the parent enrolment target (adjusted difference − 1.2%; 95% CI − 19.5%, 17.1%); 17.1% of intervention centres and 13.9% of control centres achieved the attendance target (adjusted difference 1.2%; 95% CI − 15.7%, 18.1%). Unexpectedly, the trial coincided with substantial national service restructuring, including centre closures and reduced funds. Some commissioning and management teams stopped or reduced delivery of both HENRY and the implementation optimisation intervention due to competing demands. Thus, at follow-up, HENRY programmes were delivered to approximately half the number of parents compared to baseline (n = 433 vs. 881). Conclusions During a period in which services were reduced by external policies, this first definitive trial found no evidence of effectiveness for an implementation optimisation intervention promoting parent enrolment to and attendance at an obesity prevention programme. Trial registration ClinicalTrials.govNCT02675699. Registered on 4 February 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05757-w.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, YO105DD, York, UK. .,Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
| | - Wendy Burton
- Department of Health Sciences and the Hull York Medical School, University of York, YO105DD, York, UK.,Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jane Nixon
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - June Stevens
- Departments of Nutrition and Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Kim Roberts
- HENRY Head Office, 8 Elm Place, Old Witney Road, Eynsham, OX29 4BD, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Harry Rutter
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Bethan Copsey
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.,IRSS-IRES, Université catholique de Louvain, B-1348, Louvain, La-Neuve, Belgium
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
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Arnaiz P, Adams L, Müller I, Gerber M, Walter C, du Randt R, Steinmann P, Bergman MM, Seelig H, van Greunen D, Utzinger J, Pühse U. Sustainability of a school-based health intervention for prevention of non-communicable diseases in marginalised communities: protocol for a mixed-methods cohort study. BMJ Open 2021; 11:e047296. [PMID: 34610931 PMCID: PMC8493924 DOI: 10.1136/bmjopen-2020-047296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The prevalence of chronic, lifestyle-related diseases is increasing among adults and children from low-income and middle-income countries. Despite the effectiveness of community-based interventions to address this situation, the benefits thereof may disappear in the long term, due to a lack of maintenance, especially among disadvantaged and high-risk populations. The KaziBantu randomised controlled trial conducted in 2019 consisted of two school-based health interventions, KaziKidz and KaziHealth. This study will evaluate the long-term effectiveness and sustainability of these interventions in promoting positive lifestyle changes among children and educators in disadvantaged schools in Nelson Mandela Bay, South Africa, in the context of the COVID-19 pandemic. METHODS AND ANALYSIS This study has an observational, longitudinal, mixed-methods design. It will follow up educators and children from the KaziBantu study. All 160 educators enrolled in KaziHealth will be invited to participate, while the study will focus on 361 KaziKidz children (aged 10-16 years) identified as having an increased risk for non-communicable diseases. Data collection will take place 1.5 and 2 years postintervention and includes quantitative and qualitative methods, such as anthropometric measurements, clinical assessments, questionnaires, interviews and focus group discussions. Analyses will encompass: prevalence of health parameters; descriptive frequencies of self-reported health behaviours and quality of life; the longitudinal association of these; extent of implementation; personal experiences with the programmes and an impact analysis based on the Reach, Efficacy, Adoption, Implementation, Maintenance framework. DISCUSSION In settings where resources are scarce, sustainable and effective prevention programmes are needed. The purpose of this protocol is to outline the design of a study to evaluate KaziKidz and KaziHealth under real-world conditions in terms of effectiveness, being long-lasting and becoming institutionalised. We hypothesise that a mixed-methods approach will increase understanding of the interventions' capacity to lead to sustainable favourable health outcomes amid challenging environments, thereby generating evidence for policy. TRIAL REGISTRATION NUMBER ISRCTN15648510.
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Affiliation(s)
- Patricia Arnaiz
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Larissa Adams
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Ivan Müller
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Markus Gerber
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Cheryl Walter
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Rosa du Randt
- Department of Human Movement Science, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Harald Seelig
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Darelle van Greunen
- Centre for Community Technologies, Nelson Mandela Metropolitan University, Gqberha, South Africa
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Uwe Pühse
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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11
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Jelalian E, Evans W, Darling KE, Seifer R, Vivier P, Goldberg J, Wright C, Tanskey L, Warnick J, Hayes J, Shepard D, Tuttle H, Elwy AR. Protocol for the Rhode Island CORD 3.0 Study: Adapting, Testing, and Packaging the JOIN for ME Family-Based Childhood Obesity Program in Low-Income Communities. Child Obes 2021; 17:S11-S21. [PMID: 34569839 PMCID: PMC8575054 DOI: 10.1089/chi.2021.0179] [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] [Indexed: 11/12/2022]
Abstract
Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.
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Affiliation(s)
- Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.,Address correspondence to: Elissa Jelalian, PhD, Weight Control and Diabetes Research Center, 196 Richmond Street, Providence, RI 02903, USA.
| | - Whitney Evans
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Katherine E. Darling
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Vivier
- School of Public Health, Brown University, Providence, RI, USA
| | - Jeanne Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | - Catherine Wright
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, MA, USA
| | | | - Jennifer Warnick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Jacqueline Hayes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Donald Shepard
- Heller School of Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
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12
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McLoughlin GM, Allen P, Walsh-Bailey C, Brownson RC. A systematic review of school health policy measurement tools: implementation determinants and outcomes. Implement Sci Commun 2021; 2:67. [PMID: 34174969 PMCID: PMC8235584 DOI: 10.1186/s43058-021-00169-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/08/2021] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application. METHODS Peer-reviewed journal articles published 1995-2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework. RESULTS Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability. CONCLUSIONS Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.
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Affiliation(s)
- Gabriella M McLoughlin
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
- Division of Public Health Sciences (Department of Surgery), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, USA.
| | - Peg Allen
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Callie Walsh-Bailey
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Implementation Science Center for Cancer Control (WU-ISC3) and Prevention Research Center, Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Public Health Sciences (Department of Surgery), Washington University School of Medicine, Washington University in St. Louis, St. Louis, 63110, USA
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13
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Shoesmith A, Hall A, Wolfenden L, Shelton RC, Powell BJ, Brown H, McCrabb S, Sutherland R, Yoong S, Lane C, Booth D, Nathan N. Barriers and facilitators influencing the sustainment of health behaviour interventions in schools and childcare services: a systematic review. Implement Sci 2021; 16:62. [PMID: 34118955 PMCID: PMC8199827 DOI: 10.1186/s13012-021-01134-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
Background Sustainment has been defined as the sustained use or delivery of an intervention in practice following cessation of external implementation support. This review aimed to identify and synthesise factors (barriers and facilitators) that influence the sustainment of interventions (policies, practices, or programmes) in schools and childcare services that address the leading risk factors of chronic disease. Methods Seven electronic databases and relevant reference lists were searched for articles, of any design, published in English, from inception to March 2020. Articles were included if they qualitatively and/or quantitatively reported on school or childcare stakeholders’ (including teachers, principals, administrators, or managers) perceived barriers or facilitators to the sustainment of interventions addressing poor diet/nutrition, physical inactivity, obesity, tobacco smoking, or harmful alcohol use. Two independent reviewers screened texts, and extracted and coded data guided by the Integrated Sustainability Framework, an existing multi-level sustainability-specific framework that assesses factors of sustainment. Results Of the 13,158 articles identified, 31 articles met the inclusion criteria (8 quantitative, 12 qualitative, 10 mixed-methods, and 1 summary article). Overall, 29 articles were undertaken in schools (elementary n=17, middle n=3, secondary n=4, or a combination n=5) and two in childcare settings. The main health behaviours targeted included physical activity (n=9), diet (n=3), both diet and physical activity (n=15), and smoking (n=4), either independently (n=1) or combined with other health behaviours (n=3). Findings suggest that the majority of the 59 barriers and 74 facilitators identified to impact on intervention sustainment were similar across school and childcare settings. Factors predominantly relating to the ‘inner contextual factors’ of the organisation including: availability of facilities or equipment, continued executive or leadership support present, and team cohesion, support, or teamwork were perceived by stakeholders as influential to intervention sustainment. Conclusions Identifying strategies to improve the sustainment of health behaviour interventions in these settings requires a comprehensive understanding of factors that may impede or promote their ongoing delivery. This review identified multi-level factors that can be addressed by strategies to improve the sustainment of such interventions, and suggests how future research might address gaps in the evidence base. Trial registration This review was prospectively registered on PROSPERO: CRD42020127869, Jan. 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01134-y.
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Affiliation(s)
- Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia. .,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Hannah Brown
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Serene Yoong
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, 1/Kookaburra Circuit, New Lambton Heights, 2305, NSW, Australia
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14
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Burton W, Sahota P, Twiddy M, Brown J, Bryant M. The Development of a Multilevel Intervention to Optimise Participant Engagement with an Obesity Prevention Programme Delivered in UK children's Centres. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:345-356. [PMID: 33523389 PMCID: PMC8032563 DOI: 10.1007/s11121-021-01205-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Poor participant engagement threatens the potential impact and cost-effectiveness of public health programmes preventing meaningful evaluation and wider application. Although barriers and levers to engagement with public health programmes are well documented, there is a lack of proven strategies in the literature addressing these. This paper details the development of a participant engagement intervention aimed at promoting enrolment and attendance to a community-based pre-school obesity prevention programme delivered in UK children’s centres; HENRY (Health, Exercise, Nutrition for the Really Young). The Behaviour Change Wheel framework was used to guide the development of the intervention. The findings of a coinciding focused ethnography study identified barriers and levers to engagement with HENRY that informed which behaviours should be targeted within the intervention to promote engagement. A COM-B behavioural analysis was undertaken to identify whether capability, opportunity or motivation would need to be influenced for the target behaviours to occur. APEASE criteria were used to agree on appropriate intervention functions and behaviour change techniques. A multi-level participant engagement intervention was developed to promote adoption of target behaviours that were proposed to promote engagement with HENRY, e.g. ensuring the programme is accurately portrayed when approaching individuals to attend and providing ‘taster’ sessions prior to each programme. At the local authority level, the intervention aimed to increase buy-in with HENRY to increase the level of resource dedicated to engagement efforts. At the centre level, managers were encouraged to widen promotion of the programme and ensure that staff promoted the programme accurately. HENRY facilitators received training to increase engagement during sessions, and parents that had attended HENRY were encouraged to recruit their peers. This paper describes one of the first attempts to develop a theory-based multi-level participant engagement intervention specifically designed to promote recruitment and retention to a community-based obesity prevention programme. Given the challenges to implementing public health programmes with sufficient reach, the process used to develop the intervention serves as an example of how programmes that are already widely commissioned could be optimised to enable greater impact.
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Affiliation(s)
- Wendy Burton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
| | - Pinki Sahota
- School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Cottingham Rd, Hull, HU6 7RX, UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
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15
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Lee JA, McLoughlin GM, Welk GJ. School Wellness Environments: Perceptions Versus Realities. J Sch Nurs 2020; 38:241-248. [PMID: 32390498 DOI: 10.1177/1059840520924453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The U.S. Department of Agriculture Final Rule on School Wellness Policy requires schools to self-evaluate wellness policies and environments. To understand the utility of this information, this study evaluates the validity of school-reported wellness information against directly observed data. Wellness leaders at 10 Midwestern elementary schools completed a questionnaire spanning nine school wellness settings. School-reported information was compared against a direct observation protocol. Percent agreement and κ statistics were used to assess agreement between school reporters and direct observation. Overall percent agreement between reporters and direct observation was 77.1%. Agreement ranged from 67.3% (Lunchroom Environment) to 92.0% (School Wellness Policies) across the nine categories. κ results showed that 65.7% of the items demonstrated fair or better reporter agreement. The results provide preliminary support for the utility of schools' self-reported wellness information. Facilitation of independent reporting on wellness environments by school leaders will contribute to broader applications for school wellness programming.
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Affiliation(s)
- Joey A Lee
- University of Colorado Colorado Springs, CO, USA
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16
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Smith JD, Fu E, Kobayashi MA. Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annu Rev Clin Psychol 2020; 16:351-378. [PMID: 32097572 PMCID: PMC7259820 DOI: 10.1146/annurev-clinpsy-100219-060201] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.
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Affiliation(s)
- Justin D Smith
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | - Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; ,
| | - Marissa A Kobayashi
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida 33136, USA;
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17
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Lambrinou CP, Androutsos O, Karaglani E, Cardon G, Huys N, Wikström K, Kivelä J, Ko W, Karuranga E, Tsochev K, Iotova V, Dimova R, De Miguel-Etayo P, M. González-Gil E, Tamás H, JANCSÓ Z, Liatis S, Makrilakis K, Manios Y. Effective strategies for childhood obesity prevention via school based, family involved interventions: a critical review for the development of the Feel4Diabetes-study school based component. BMC Endocr Disord 2020; 20:52. [PMID: 32370795 PMCID: PMC7201517 DOI: 10.1186/s12902-020-0526-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Although there are many interventions targeting childhood obesity prevention, only few have demonstrated positive results. The current review aimed to gather and evaluate available school-based intervention studies with family involvement targeting dietary, physical activity and sedentary behaviors among primary schoolchildren and their families, in order to identify the most effective strategies. METHODS Studies published between 2000 and January 2015 were retrieved from scientific electronic databases and grey literature. The databases used included MEDLINE/PubMed, Web-of-Science, CINAHL and Scopus. Included studies had to be experimental controlled studies and had duration over 1 school year, had family involvement, combined PA and dietary behaviors and were implemented in school setting. A complementary search was executed to update the review to cover the period from February 2015 to January 2019. RESULTS From the studies examined (n = 425), 27 intervention programs (33 publications) fulfilled the inclusion criteria. Among these, 15 presented significant effect on weight status and/ or overweight/ obesity or clinical indices, 3 presented significant effect on most energy balance-related behaviors (EBRBs) while 9 presented significant effect on some/few EBRBs or determinants. Strategies implemented in effective interventions were: teachers acting as role-models and being actively involved in the delivery of the intervention, school policies supporting the availability of healthy food and beverage choices and limiting unhealthy snacks, changes in the schoolyard, in the recess rules and in the physical education classes to increase physical activity, and involving parents in the intervention via assignments, meetings, informative material and encouraging them to improve the home environment. Use of incentives for children, social marketing techniques, collaboration with local stakeholders were found to increase effectiveness. Programs that focused only on educational sessions and material for parents, without promoting relevant environmental and policy changes, were found to be less effective. Cultural adaptations have been suggested to increase the intervention's acceptance in specific or vulnerable population groups. CONCLUSIONS Several effective strategies were identified in the reviewed programs. Outcomes of the current review were taken into account in developing the Feel4Diabetes-intervention and summed up as recommendations in the current work in order to facilitate other researchers designing similar childhood obesity prevention initiatives.
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Affiliation(s)
- Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Eva Karaglani
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nele Huys
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Winne Ko
- International Diabetes Federation European Region, Brussels, Belgium
| | - Ernest Karuranga
- International Diabetes Federation European Region, Brussels, Belgium
| | - Kaloyan Tsochev
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Roumyana Dimova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | - Pilar De Miguel-Etayo
- Growth, Exercise, NUtrition and Development (GENUD) Research Group. Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain
| | - Esther M. González-Gil
- Growth, Exercise, NUtrition and Development (GENUD) Research Group. Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, Zaragoza, Spain
- Institute of Nutrition and Food Technology. Department of Biochemistry and Molecular Biology II, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Hajnalka Tamás
- University of Debrecen, Department of Family and Occupational Medicine, Debrecen, Hungary
| | - Zoltán JANCSÓ
- University of Debrecen, Department of Family and Occupational Medicine, Debrecen, Hungary
| | - Stavros Liatis
- National and Kapodistrian University of Athens, Athens, Greece
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
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18
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Safety and Health Innovation in Preschools: A Total Worker Health Pilot Project. J Occup Environ Med 2020; 62:e192-e199. [PMID: 32149941 DOI: 10.1097/jom.0000000000001848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The primary objective of this study was to evaluate quality of work life in early childhood education (ECE) centers and implement a total worker health (TWH) pilot project with a small sample of ECE teachers. METHODS An evidence-based strategic planning process to make policy, system, and environmental (PSE) changes related to TWH was implemented with six ECE centers. A pre-post design with mixed-methods was used to evaluate the impact. RESULTS Baseline findings suggest that there are significant disparities related to quality of work life among ECE teachers compared with the national population. After implementation of the pilot project, ECE centers averaged 4.7 PSE changes. Qualitative data informed facilitators and barriers to implementation of TWH-related changes. CONCLUSIONS This pilot project reflects an evidence-based participatory approach to assessing and improving the well-being of ECE teachers.
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19
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Zoellner JM, Porter KJ, You W, Chow PI, Ritterband LM, Yuhas M, Loyd A, McCormick BA, Brock DJP. Kids SIPsmartER, a cluster randomized controlled trial and multi-level intervention to improve sugar-sweetened beverages behaviors among Appalachian middle-school students: Rationale, design & methods. Contemp Clin Trials 2019; 83:64-80. [PMID: 31233859 PMCID: PMC6713199 DOI: 10.1016/j.cct.2019.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/07/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
Abstract
The intake of sugar-sweetened beverages (SSB) is disproportionately high in Appalachia, including among adolescents whose intake is more than double the national average and more than four times the recommended daily amount. Unfortunately, there is insufficient evidence for effective strategies targeting SSB behaviors among Appalachian youth in real-world settings, including rural schools. Kids SIPsmartER is a 6-month, school-based, behavior and health literacy program aimed at improving SSB behaviors among middle school students. The program also integrates a two-way short message service (SMS) strategy to engage caregivers in SSB role modeling and supporting home SSB environment changes. Kids SIPsmartER is grounded by the Theory of Planned Behavior and health literacy, media literacy, numeracy, and public health literacy concepts. Guided by the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), this type 1 hybrid design and cluster randomized controlled trial targets 12 Appalachian middle schools in southwest Virginia. The primary aim evaluates changes in SSB behaviors at 7-months among 7th grade students at schools receiving Kids SIPsmartER, as compared to control schools. Secondary outcomes include other changes in students (e.g., BMI, quality of life, theory-related variables) and caregivers (e.g., SSB behaviors, home SSB environment), and 19-month maintenance of these outcomes. Reach is assessed, along with mixed-methods strategies (e.g., interviews, surveys, observation) to determine how teachers implement Kids SIPsmartER and the potential for institutionalization within schools. This paper discusses the rationale for implementing and evaluating a type 1 hybrid design and multi-level intervention addressing pervasive SSB behaviors in Appalachia. Clincialtrials.gov: NCT03740113.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Kathleen J Porter
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 321A Hutcheson Hall, 24060, USA
| | - Phillip I Chow
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Lee M Ritterband
- University of Virginia, Department of Psychiatry and Neurobehavioral Sciences, 560 Ray C Hunt Drive, Charlottesville, Virginia 22908, USA
| | - Maryam Yuhas
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Annie Loyd
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Brittany A McCormick
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Donna-Jean P Brock
- University of Virginia, Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
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Lee JA, Welk GJ. Association Between Comprehensive School Physical Activity Program Implementation and Principal Support. Health Promot Pract 2019; 22:257-265. [PMID: 31315464 DOI: 10.1177/1524839919862767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of Comprehensive School Physical Activity Program (CSPAP) has been recommended to help students achieve 60-minutes of physical activity each day. Implementing a CSPAP requires planning, coordination, and ongoing oversight, but an understudied factor is how principal support influences CSPAP implementation. The purpose of this study was to evaluate the impact of principal support on CSPAP implementation. Method. Schools in the Iowa FitnessGram Initiative (n = 84), a participatory network of schools committed to supporting physical education and wellness efforts, were invited to participate in the study. Physical education teachers from 42 schools completed a survey assessing CSPAP implementation and principal support for school wellness. Descriptive statistics and correlation analyses were used to report associations between the variables. A regression analysis was conducted to evaluate the impact of principal support on CSPAP implementation. Results. Almost half of the schools were reported to be fully implementing just one CSPAP component and no school was reported to be fully implementing all five. The CSPAP component with the highest reported level of implementation was quality physical education, while the lowest level of implementation was reported for family and community engagement and staff involvement. The regression analysis identified that principal support was a significant predictor of CSPAP implementation, b = 0.55, t(37) = 3.10, p < .004. Conclusions. Principal support is associated with implementation of CSPAP initiatives. Strategies that focus on how to attain principal support for CSPAP initiatives are needed and could have a significant impact on student physical activity and health.
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Affiliation(s)
- Joey A Lee
- University of Colorado Colorado Springs, Colorado Springs, CO, USA
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21
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Tabak RG, Schwarz CD, Kemner A, Schechtman KB, Steger-May K, Byrth V, Haire-Joshu D. Disseminating and implementing a lifestyle-based healthy weight program for mothers in a national organization: a study protocol for a cluster randomized trial. Implement Sci 2019; 14:68. [PMID: 31238955 PMCID: PMC6593605 DOI: 10.1186/s13012-019-0916-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Excessive weight gain among young adult women age 18–45 years is an alarming and overlooked trend that must be addressed to reverse the epidemics of obesity and chronic disease. During this vulnerable period, women tend to gain disproportionally large amounts of weight compared to men and to other life periods. Healthy Eating and Active Living Taught at Home (HEALTH) is a lifestyle modification intervention developed in partnership with Parents as Teachers (PAT), a national home visiting, community-based organization with significant reach in this population. HEALTH prevented weight gain, promoted sustained weight loss, and reduced waist circumference. PAT provides parent–child education and services free of charge to nearly 170,000 families through up to 25 free home visits per year until the child enters kindergarten. Methods This study extends effectiveness findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation (D&I) of HEALTH across three levels (mother, parent educator, PAT site). The trial will evaluate the effect of HEALTH and the HEALTH training curriculum (implementation strategy) on weight among mothers with overweight and obesity across the USA (N = 252 HEALTH; N = 252 usual care). Parent educators from 28 existing PAT sites (14 HEALTH, 14 usual care) will receive the HEALTH training curriculum through PAT National Center, using PAT’s existing training infrastructure, as a continuing education opportunity. An extensive evaluation, guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation) at the parent educator level. The Conceptual Framework for Implementation Research will characterize determinants that influence HEALTH D&I at three levels: mother, parent educator, and PAT site to enhance external validity (reach and maintenance). Discussion Embedding intervention content within existing delivery channels can help expand the reach of evidence-based interventions. Interventions, which have been adapted, can still be effective even if the effect is reduced and can still achieve population impact by reaching a broader set of the population. The current study will build on this to test not only the effectiveness of HEALTH in real-world PAT implementation nationwide, but also elements critical to D&I, implementation outcomes, and the context for implementation. Trial registration https://ClinicalTrials.gov, NCT03758638. Registered 29 November 2018 Electronic supplementary material The online version of this article (10.1186/s13012-019-0916-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Allison Kemner
- Research and Quality, Parents as Teachers, 2228 Ball Drive, St. Louis, MO, 63146, USA
| | - Kenneth B Schechtman
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Karen Steger-May
- Division of Biostatistics, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Ave., CB 8067, St. Louis, MO, 63110-1093, USA
| | - Veronda Byrth
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Debra Haire-Joshu
- The Brown School and The School of Medicine, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
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Dunn CG, Burgermaster M, Adams A, Koch P, Adintori PA, Stage VC. A Systematic Review and Content Analysis of Classroom Teacher Professional Development in Nutrition Education Programs. Adv Nutr 2019; 10:351-359. [PMID: 30668616 PMCID: PMC6416037 DOI: 10.1093/advances/nmy075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/23/2018] [Accepted: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
Many nutrition programs include classroom-based education. Schoolteachers are relied upon to deliver these programs despite gaps in nutrition education motivation, knowledge, and self-efficacy. Teacher professional development (PD) for these nutrition education programs has been identified as a strategy for improving program effectiveness, yet many interventions do not include a PD component and still fewer describe it. A literature search was conducted between January and February 2017; articles were collected from PubMed, ERIC, and EBSCOhost. Article inclusion criteria were as follows: 1) published in an English-language peer-reviewed or scholarly journal, 2) published after 2000, 3) empirical research, 4) research conducted in a K-12 classroom, 5) research included nutrition education component, and 6) program delivered by a classroom teacher. Twenty-seven interventions were identified. A team of 2 researchers performed content analysis based on an evidence-based set of 7 PD components to assess if and how these components were incorporated before, during, or after program implementation. Little information was provided that described the role of teacher PD in the course of delivering nutrition education in classroom-based programs. The most common elements of PD described in the literature were the time spent in PD and follow-up with instructors during or after program implementation. There was a notable lack of methodologic description of teacher PD, and this limited reporting may decrease researchers' ability to work with teachers in a consistent and effective manner.
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Affiliation(s)
- Caroline G Dunn
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA
| | - Marissa Burgermaster
- Nutritional Sciences, College of Natural Sciences, and
- Population Health, Dell Medical School, University of Texas at Austin, Austin, TX
| | - Alyson Adams
- School of Teaching and Learning, College of Education, University of Florida, Gainesville, FL
| | - Pamela Koch
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Peter A Adintori
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, NY
| | - Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Gainesville, NC
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23
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Hayes CB, O'Shea MP, Foley-Nolan C, McCarthy M, Harrington JM. Barriers and facilitators to adoption, implementation and sustainment of obesity prevention interventions in schoolchildren- a DEDIPAC case study. BMC Public Health 2019; 19:198. [PMID: 30767770 PMCID: PMC6377757 DOI: 10.1186/s12889-018-6368-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/27/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aim of the study was to explore the implementation of school based diet and physical activity interventions with respect to the barriers and facilitators to adoption, implementation and sustainability; supportive actions required for implementation and recommendations to overcome identified barriers. Two interventions rolled out nationally in Ireland were chosen; Food Dudes, a programme to encourage primary school children to consume more fruit and vegetables and Green Schools Travel (GST), an active travel to school programme in primary and secondary schools. Trained school coordinators (teachers) cascade the programmes to other teaching staff. METHODS Multiple case study design using qualitative semi-structured interviews with key stakeholders: primary and secondary school teachers, school coordinators, project coordinators/managers, funders and intermediaries. Fifteen interviews were conducted. Data were coded using a common categorization matrix. Thematic analysis was undertaken using the Adoption, Implementation and Maintenance elements of the RE-AIM implementation framework. RESULTS Good working relationships within and across government departments, intermediaries and schools were critical for intervention adoption, successful implementation and sustainability. Organisational and leadership ability of coordinators were essential. Provision of participation incentives acted as motivators to engage children's interest. A deep understanding of the lives of the target children was an important contextual factor. The importance of adaptation without compromising core components in enhancing intervention sustainability emerged. Successful implementation was hindered by: funding insecurity, school timetable constraints, broad rather than specific intervention core components, and lack of agreement on conduct of programme evaluation. Supportive actions for maintenance included ongoing political support, secure funding and pre-existing healthy lifestyle policies. CONCLUSIONS Successful implementation and scale up of public health anti-obesity interventions in schools is dependent on good contextual fit, engagement and leadership at multiple levels and secure funding. Recommendations to overcome barriers include: capacity to deliver within an already overcrowded curriculum and clear specification of intervention components within a conceptual framework to facilitate evaluation. Our findings are generalisable across different contexts and are highly relevant to those involved in the development or adaptation, organisation or execution of national public health interventions: policy makers, guidelines developers, and staff involved in local organisation and delivery.
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Affiliation(s)
- C B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - M P O'Shea
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - C Foley-Nolan
- Safefood and School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - M McCarthy
- Cork University Business School, University College Cork, Cork, Ireland
| | - J M Harrington
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
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24
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Ruggiero CF, Poirier L, Trude ACB, Yang T, Schwendler T, Gunen B, Loh IH, Perepezko K, Nam CS, Sato P, Gittelsohn J. Implementation of B'More Healthy Communities for Kids: process evaluation of a multi-level, multi-component obesity prevention intervention. HEALTH EDUCATION RESEARCH 2018; 33:458-472. [PMID: 30202959 PMCID: PMC6293311 DOI: 10.1093/her/cyy031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 05/10/2023]
Abstract
B'More Healthy Communities for Kids was a multi-level, multi-component obesity prevention intervention to improve access, demand and consumption of healthier foods and beverages in 28 low-income neighborhoods in Baltimore City, MD. Process evaluation assesses the implementation of an intervention and monitor progress. To the best of our knowledge, little detailed process data from multi-level obesity prevention trials have been published. Implementation of each intervention component (wholesaler, recreation center, carryout restaurant, corner store, policy and social media/text messaging) was classified as high, medium or low according to set standards. The wholesaler component achieved high implementation for reach, dose delivered and fidelity. Recreation center and carryout restaurant components achieved medium reach, dose delivered and fidelity. Corner stores achieved medium reach and dose delivered and high fidelity. The policy component achieved high reach and medium dose delivered and fidelity. Social media/text messaging achieved medium reach and high dose delivered and fidelity. Overall, study reach and dose delivered achieved a high implementation level, whereas fidelity achieved a medium level. Varying levels of implementation may have balanced the performance of an intervention component for each process evaluation construct. This detailed process evaluation of the B'More Healthy Communities for Kids allowed the assessment of implementation successes, failures and challenges of each intervention component.
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Affiliation(s)
- C F Ruggiero
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - L Poirier
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A C B Trude
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Yang
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - T Schwendler
- Peace Corps, Serekunda, The Gambia, Washington, DC, USA
| | - B Gunen
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - I H Loh
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - K Perepezko
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - C S Nam
- Joint Learning Initiative on Faith and Local Communities, Washington, DC, USA
| | - P Sato
- University of S�o Paulo, S�o Paulo, SP, Brazil
| | - J Gittelsohn
- Global Obesity Prevention Center, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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25
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Affiliation(s)
- Leonard Jack
- Office of Medicine and Science, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-80, Atlanta, GA 30341.
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Chen S, Dzewaltowski DA, Rosenkranz RR, Lanningham-Foster L, Vazou S, Gentile DA, Lee JA, Braun KJ, Wolff MM, Welk GJ. Feasibility study of the SWITCH implementation process for enhancing school wellness. BMC Public Health 2018; 18:1119. [PMID: 30217186 PMCID: PMC6137879 DOI: 10.1186/s12889-018-6024-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a need to identify strategies that enhance the implementation of evidence-based school wellness intervention programs in real-world settings. The present study evaluates the feasibility of empowering school wellness leaders to deliver an evidence-based, childhood obesity-prevention program called Switch ™. We specifically evaluated the feasibility of a new implementation framework, based on the robust Healthy Youth Places framework, to increase capacity of school leaders to lead school wellness programming. METHODS The SWITCH (School Wellness Integration Targeting Child Health) implementation process was evaluated in a convenience sample of eight Iowa elementary schools. Teams of three leaders from each school attended an in-person school wellness conference followed by five online webinar sessions delivered by two SWITCH team members. The capacity-building and quality improvement process was designed to empower schools to lead wellness change using methods and concepts from the original 16-week Switch ™ program. School wellness leaders completed checklists on two occasions to assess overall school-level implementation as well as setting-level changes in physical education, classrooms, and the lunchroom. Student acceptability of SWITCH was evaluated by the degree of behavior tracking using an online SWITCH Tracker system that promoted self-monitoring. School acceptability and practicality were assessed through an exit survey completed by school leaders. RESULTS All school staff reported satisfaction with the SWITCH implementation process. Reports of school- and setting-level implementation were relatively high (2.0 to 2.8 on a 3-point scale) but student engagement, based on use of the online tracking system, varied greatly over time and across schools. Three high implementation schools had average tracking rates exceeding 70% (range: 72-90%) while three low implementation schools had rates lower than 30% (range = 0-23%). CONCLUSIONS This feasibility study supports the utility of the new implementation framework for promoting school and student engagement with SWITCH. Further testing regarding effectiveness and scale-up of this evidence-based school wellness intervention program is warranted.
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Affiliation(s)
- Senlin Chen
- School of Kinesiology, Louisiana State University, 175C Huey P. Long Field House, Baton Rouge, LA 70803 USA
| | - David A. Dzewaltowski
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198 USA
- Buffett Early Childhood Institute, University of Nebraska, Omaha, NE 68106 USA
| | - Richard R. Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS 66506 USA
| | | | - Spyridoula Vazou
- Department of Kinesiology, Iowa State University, Ames, IA 50011 USA
| | | | - Joey A. Lee
- Department of Health Sciences, University of Colorado at Colorado Springs, Colorado Springs, CO 80918 USA
| | - Kyle J. Braun
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS 66506 USA
| | - Maren M. Wolff
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA 50011 USA
| | - Gregory J. Welk
- Department of Kinesiology, Iowa State University, Ames, IA 50011 USA
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27
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Measuring implementation fidelity of school-based obesity prevention programmes: a systematic review. Int J Behav Nutr Phys Act 2018; 15:75. [PMID: 30103764 PMCID: PMC6088402 DOI: 10.1186/s12966-018-0709-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
Background Until now, there is no clear overview of how fidelity is assessed in school-based obesity prevention programmes. In order to move the field of obesity prevention programmes forward, the current review aimed to 1) identify which fidelity components have been measured in school-based obesity prevention programmes; 2) identify how fidelity components have been measured; and 3) score the quality of these methods. Methods Studies published between January 2001–October 2017 were selected from searches in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library and ERIC. We included studies examining the fidelity of obesity prevention programmes (nutrition and/or physical activity and/or sitting) at school (children aged 4–18 year) measuring at least one component of implementation fidelity. A data extraction was performed to identify which and how fidelity components were measured. Thereafter, a quality assessment was performed to score the quality of these methods. We scored each fidelity component on 7 quality criteria. Each fidelity component was rated high (> 75% positive), moderate (50–75%) or low (< 50%). Results Of the 26,294 retrieved articles, 73 articles reporting on 63 different studies were included in this review. In 17 studies a process evaluation was based on a theoretical framework. In total, 120 fidelity components were measured across studies: dose was measured most often (N = 50), followed by responsiveness (N = 36), adherence (N = 26) and quality of delivery (N = 8). There was substantial variability in how fidelity components were defined as well as how they were measured. Most common methods were observations, logbooks and questionnaires targeting teachers. The quality assessment scores ranged from 0 to 86%; most fidelity components scored low quality (n = 77). Conclusions There is no consensus on the operationalisation of concepts and methods used for assessing fidelity in school-based obesity prevention programmes and the quality of methods used is weak. As a result, we call for more consensus on the concepts and clear reporting on the methods employed for measurements of fidelity to increase the quality of fidelity measurements. Moreover, researchers should focus on the relation between fidelity and programme outcomes and determine to what extent adaptations to programmes have been made, whilst still being effective. Electronic supplementary material The online version of this article (10.1186/s12966-018-0709-x) contains supplementary material, which is available to authorized users.
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Lessons learned and insights from the implementation of a food and physical activity policy to prevent obesity in Mexican schools: An analysis of nationally representative survey results. PLoS One 2018; 13:e0198585. [PMID: 29944659 PMCID: PMC6019747 DOI: 10.1371/journal.pone.0198585] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/22/2018] [Indexed: 11/19/2022] Open
Abstract
Obesity is a serious problem among children in Mexico. In 2010, the government implemented a national food and physical activity policy in elementary schools, to prevent obesity. The goal of this study is to assess the implementation of this policy, using the logic model from a descriptive survey with national representativeness at the elementary school level and based on a stratified cluster design. We used a systematic random sampling of schools (n = 122), stratified into public and private. We administered questionnaires to 116 principals, 165 members of the Food and Physical Activity Committees, 132 food school food vendors, 119 teachers, 348 parents. This study evidences a significant deviation in implementation from what had been planned. Our lessons learned are the importance to: base the design/implementation of the policy on a theoretical framework, make programs appealing to stakeholders, select concrete and measurable objective or goals, and support stakeholders during the implementation process.
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Hemmingsson E. Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication. Curr Obes Rep 2018; 7:204-209. [PMID: 29704182 PMCID: PMC5958160 DOI: 10.1007/s13679-018-0310-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW To explore the sequence and interaction of infancy and early childhood risk factors, particularly relating to disturbances in the social environment, and how the consequences of such exposures can promote weight gain and obesity. RECENT FINDINGS This review will argue that socioeconomic adversity is a key upstream catalyst that sets the stage for critical midstream risk factors such as family strain and dysfunction, offspring insecurity, stress, emotional turmoil, low self-esteem, and poor mental health. These midstream risk factors, particularly stress and emotional turmoil, create a more or less perfect foil for calorie-dense junk food self-medication and subtle addiction, to alleviate uncomfortable psychological and emotional states. Disturbances in the social environment during infancy and early childhood appear to play a critical role in weight gain and obesity, through such mechanisms as insecurity, stress, and emotional turmoil, eventually leading to junk food self-medication and subtle addiction.
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Affiliation(s)
- Erik Hemmingsson
- The Swedish School of Sport and Health Sciences, Box 5626, 114 86, Stockholm, Sweden.
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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Dooyema CA, Belay B, Blanck HM. Implementation of Multisetting Interventions to Address Childhood Obesity in Diverse, Lower-Income Communities: CDC's Childhood Obesity Research Demonstration Projects. Prev Chronic Dis 2017; 14:E140. [PMID: 29267154 PMCID: PMC5743023 DOI: 10.5888/pcd14.170491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carrie A Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, MS F-77, Atlanta, GA 30341.
| | - Brook Belay
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta Georgia
| | - Heidi M Blanck
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease and Health Promotion, Centers for Disease Control and Prevention, Atlanta Georgia.,US Public Health Service, Atlanta, Georgia
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Franckle RL, Falbe J, Gortmaker S, Barrett JL, Giles C, Ganter C, Blaine RE, Buszkiewicz J, Taveras EM, Kwass JA, Land T, Davison KK. Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project. Obesity (Silver Spring) 2017; 25:1175-1182. [PMID: 28653502 PMCID: PMC5488705 DOI: 10.1002/oby.21867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 03/17/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls. METHODS MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention. RESULTS Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01). CONCLUSIONS This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.
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Affiliation(s)
- Rebecca L. Franckle
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jennifer Falbe
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, CA
| | - Steven Gortmaker
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Jessica L. Barrett
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Catherine Giles
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claudia Ganter
- Medical Faculty Mannheim, Heidelberg University, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany
| | - Rachel E. Blaine
- Department of Family and Consumer Sciences, California State University, Long Beach, CA
| | - James Buszkiewicz
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Elsie M. Taveras
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, Boston, MA
| | - Kirsten K. Davison
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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