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Luke DA, Powell BJ, Paniagua-Avila A. Bridges and Mechanisms: Integrating Systems Science Thinking into Implementation Research. Annu Rev Public Health 2024; 45:7-25. [PMID: 38100647 DOI: 10.1146/annurev-publhealth-060922-040205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
We present a detailed argument for how to integrate, or bridge, systems science thinking and methods with implementation science. We start by showing how fundamental systems science principles of structure, dynamics, information, and utility are relevant for implementation science. Then we examine the need for implementation science to develop and apply richer theories of complex systems. This can be accomplished by emphasizing a causal mechanisms approach. Identifying causal mechanisms focuses on the "cogs and gears" of public health, clinical, and organizational interventions. A mechanisms approach focuses on how a specific strategy will produce the implementation outcome. We show how connecting systems science to implementation science opens new opportunities for examining and addressing social determinants of health and conducting equitable and ethical implementation research. Finally, we present case studies illustrating successful applications of systems science within implementation science in community health policy, tobacco control, health care access, and breast cancer screening.
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Affiliation(s)
- Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School; Center for Dissemination & Implementation, Institute for Public Health; and Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Farewell CV, Bergling E, Maiurro E, Puma J. Application of an Implementation Framework Using Mixed Methods in Preschool Settings. Health Promot Pract 2023; 24:272-281. [PMID: 34743643 DOI: 10.1177/15248399211053583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research Findings. Application of mixed methods in a dissemination and implementation framework can give researchers a better understanding of the reach and delivery of early childhood obesity prevention programs in preschool settings, as well as potential facilitators and barriers related to implementation and sustainability. This study utilized a simultaneous, exploratory, mixed-methods design to investigate individual-, organizational-, and intervention-level factors that were related to the implementation and sustainability of policy, system, and environment (PSE) changes as part of a larger obesity prevention program in a randomly selected sample of preschool centers (n = 20). Individual-level factors, and specifically the attitudes and skills of preschool providers, were identified in both the qualitative and quantitative data as important factors related to the sustainability of PSE changes (r = .56, p < .01). Staff and leadership engagement and adaptability of the program were also identified as important factors related to the implementation and sustainability of PSE changes. Practice or Policy. These findings highlight the complexity of implementation success and suggest PSE obesity prevention interventions in preschool centers require the consideration of numerous, multilevel factors to ensure programming is impactful and sustained over time.
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Affiliation(s)
| | | | | | - Jini Puma
- University of Colorado Denver, Aurora, CO, USA
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Nutrition and oral health in early childhood: associations with formal and informal childcare. Public Health Nutr 2020; 24:1438-1448. [PMID: 32718367 DOI: 10.1017/s1368980020001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine associations between childcare type and nutrition and oral health indicators. DESIGN Cross-sectional data extracted from a longitudinal birth cohort. Parent-completed FFQ and questions regarding oral health and childcare use. The associations between childcare type, classified into four groups: parent care only (PCO), formal childcare only (FCO), informal childcare only (ICO) or combination of care (F&I), and nutrition and oral health indicators were examined. SETTING Home and childcare. PARTICIPANTS Families with children aged 3 years (n 273) and 4 years (n 249) in Victoria, Australia. RESULTS No associations were observed between childcare type and core food/beverage consumption or oral health indicators. For discretionary beverages, compared with children receiving PCO at age 3 years, children in FCO or F&I were less likely to frequently consume fruit juice/drinks (FCO: adjusted OR (AOR) 0·41, 95 % CI 0·17, 0·96, P = 0·04; F&I: AOR 0·32, 95 % CI 0·14, 0·74, P = 0·008). At age 4 years, children receiving FCO or ICO were less likely to consume sweet beverages frequently compared with children receiving PCO: fruit juice/drink (ICO: AOR 0·42, 95 % CI 0·19, 0·94, P = 0·03; FCO: AOR 0·35, 95 % CI 0·14, 0·88, P = 0·03) and soft drink (ICO: AOR 0·23, 95 % CI 0·07, 0·74, P = 0·01; FCO: AOR 0·14, 95 % CI 0·03, 0·76, P = 0·02). CONCLUSIONS Associations between childcare type and discretionary beverage intake were observed. Investigation into knowledge, attitudes and activities in formal and informal childcare settings is required to explore different health promotion practices that may influence nutrition and oral health.
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Green AM, Mihrshahi S, Innes-Hughes C, O'Hara BJ, McGill B, Rissel C. Implementation of an Early Childhood Healthy Eating and Physical Activity Program in New South Wales, Australia: Munch & Move. Front Public Health 2020; 8:34. [PMID: 32154206 PMCID: PMC7047441 DOI: 10.3389/fpubh.2020.00034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 02/03/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Childhood obesity is an important public health issue. Approximately 20% of 2–4 year olds are overweight or obese, meaning 1 in 5 Australian children start school above a healthy weight. In the state of New South Wales (NSW) the combined prevalence of childhood overweight and obesity is significantly higher among children from low socioeconomic status backgrounds and children from regional, rural and remote areas. This paper describes implementation of a healthy eating and active play program (Munch & Move) for center-based early childhood education and care (ECEC) services aimed at influencing healthy behaviors in young children in NSW, Australia. It shows changes over time including a focus on disadvantaged, Aboriginal and remote communities. It also discusses the challenges and future opportunities for the program. Methods: Routine data in relation to service delivery (reach) and implementation indicators are collected by Local Health District staff. Fifteen implementation indicators (known as practices) were introduced to monitor the implementation of Munch & Move (six related to promoting and encouraging healthy eating, four related to improving physical activity, two related to small screen recreation; and three related to quality of service delivery). Results: As of 30 June 2017, 88.4% of ECEC services have staff trained in Munch & Move. Of the 15 practices related to promoting and encouraging healthy eating, increasing physical activity and improving the quality of service delivery 13 practices saw significant improvements between 2012 and 2017. This was consistent for services with a high proportion of Aboriginal children and for services in disadvantaged and remote communities. There has been a statistically significant increase in the proportion (37.6–81.0%, p < 0.0001) and type of ECEC services (preschools 36.1–81.3%, p < 0.0001, long day care 38.6–81.0%, p < 0.0001, and occasional care 34.0–74.6%, p < 0.0001) that have implemented the program since 2012 as well as in services with a high proportion of Aboriginal children (33.6–85.2% p < 0.0001), services in disadvantaged communities (37.4–83.3% p < 0.001), and services in remote communities (27.8–59.4% p < 0.0139). Discussion: This paper demonstrates that Munch & Move has seen large improvements in the delivery of training, practice achievements and program adoption in ECEC services across NSW including services in disadvantaged and remote communities and that have a higher proportion of Aboriginal children.
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Affiliation(s)
- Amanda M Green
- NSW Office of Preventive Health, Liverpool, NSW, Australia
| | - Seema Mihrshahi
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Blythe J O'Hara
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Bronwyn McGill
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Liverpool, NSW, Australia.,Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Kasman M, Hammond RA, Heuberger B, Mack-Crane A, Purcell R, Economos C, Swinburn B, Allender S, Nichols M. Activating a Community: An Agent-Based Model of Romp & Chomp, a Whole-of-Community Childhood Obesity Intervention. Obesity (Silver Spring) 2019; 27:1494-1502. [PMID: 31343115 PMCID: PMC6707874 DOI: 10.1002/oby.22553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Successful whole-of-community childhood obesity prevention interventions tend to involve community stakeholders in spreading knowledge about and engagement with obesity prevention efforts through the community. This process is referred to by the authors as stakeholder-driven community diffusion (SDCD). This study uses an agent-based model in conjunction with intervention data to increase understanding of how SDCD operates. METHODS This agent-based model retrospectively simulated SDCD during Romp & Chomp, a 4-year whole-of-community childhood obesity prevention intervention in Victoria, Australia. Stakeholder survey data, intervention records, and expert estimates were used to parameterize the model. Model output was evaluated against criteria derived from empirical data and experts' estimates of the magnitude and timing of community knowledge and engagement change. RESULTS The model was able to produce outputs that met the evaluation criteria: increases in simulated community knowledge and engagement driven by SDCD closely matched expert estimates of magnitude and timing. CONCLUSIONS Strong suggestive evidence was found in support of a hypothesis that SDCD was a key driver of the success of the Romp & Chomp intervention. Model exploration also provided additional insights about these processes (including where additional data collection might prove most beneficial), as well as implications for the design and implementation of future interventions.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Economics Studies Program, The Brookings Institution, Washington, DC
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, Economics Studies Program, The Brookings Institution, Washington, DC
| | - Benjamin Heuberger
- Center on Social Dynamics and Policy, Economics Studies Program, The Brookings Institution, Washington, DC
- Contact info: The Brookings Institution, 1775 Massachusetts Avenue NW, Washington, DC 20036.
| | - Austen Mack-Crane
- Center on Social Dynamics and Policy, Economics Studies Program, The Brookings Institution, Washington, DC
| | - Rob Purcell
- Center on Social Dynamics and Policy, Economics Studies Program, The Brookings Institution, Washington, DC
| | - Christina Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
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6
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Brown T, Moore THM, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 271] [Impact Index Per Article: 54.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | - Theresa HM Moore
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Lee Hooper
- University of East AngliaNorwich Medical SchoolNorwich Research ParkNorwichNorfolkUKNR4 7TJ
| | - Yang Gao
- Hong Kong Baptist UniversityDepartment of Sport and Physical EducationKowloonHong Kong
| | - Amir Zayegh
- The Royal Children's HospitalGeneral MedicineMelbourneVictoriaAustralia3052
| | - Sharea Ijaz
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Martha Elwenspoek
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge HallBristolUKBS8 2PS
- NIHR CLAHRC West at University Hospitals Bristol NHS Foundation TrustBristol‐ None ‐UKBS1 2NT
| | - Sophie C Foxen
- Royal Air Force High WycombeDefence Medical ServicesNaphillBucksUKHP14 4UE
| | - Lucia Magee
- Royal United HospitalMedical DepartmentBathUK
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
| | | | - Carolyn D Summerbell
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUK
- Fuse, the NIHR Centre for Translational Research in Public HealthDurhamUK
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Renzaho AMN, Green J, Smith BJ, Polonsky M. Exploring Factors Influencing Childhood Obesity Prevention Among Migrant Communities in Victoria, Australia: A Qualitative Study. J Immigr Minor Health 2019; 20:865-883. [PMID: 28702815 DOI: 10.1007/s10903-017-0620-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite the availability of numerous obesity prevention initiatives in developed countries including Australia, rising childhood obesity levels have been found among migrant communities which contribute to widening obesity-related disparities in these countries. We sought to understand the factors influencing the participation of migrant communities in childhood obesity prevention initiatives. We conducted a qualitative study using semi-structured interviews among 48 migrant parents from African, Middle Eastern, Indian and Vietnamese origins living in disadvantaged areas of Victoria, Australia to explore their views on childhood obesity and its prevention. Thematic analysis showed low obesity literacy among migrant communities, cultural influences negatively impacting their healthy lifestyle behaviours and cultural, family-level and community-level barriers impacting their participation in childhood obesity prevention initiatives. There is an urgent need to improve obesity literacy among migrant communities using bicultural workers in order to improve their responsiveness to childhood obesity prevention initiatives. Health interventionists are urged to incorporate culturally-mediated influences in the design of obesity prevention programs to achieve energy balance and maintain healthy weight among migrants. Such culturally appropriate approaches have the potential of reducing the widening ethnic-related obesity disparities in Australia.
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Affiliation(s)
- Andre M N Renzaho
- Humanitarian and Development Studies, School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Julie Green
- Population Health, Murdoch Children's Research Institute, Flemington Rd., Parkville, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Flemington Rd., Parkville, VIC, 3052, Australia.,Raising Children Network, Parenting Research Centre, 232 Victoria Pde, East Melbourne, VIC, 3002, Australia
| | - Ben J Smith
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Michael Polonsky
- Dept. of Marketing, Deakin Business School, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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Whelan J, Love P, Millar L, Allender S, Bell C. Sustaining obesity prevention in communities: a systematic narrative synthesis review. Obes Rev 2018; 19:839-851. [PMID: 29603583 DOI: 10.1111/obr.12675] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 01/01/2023]
Abstract
Obesity is a global problem for which sustainable solutions are yet to be realized. Community-based interventions have improved obesity-related behaviours and obesity in the short term. Few papers have explored how to make the interventions and their intended outcomes sustainable. The aim of this paper is to identify factors that contribute to the sustainability of community-based obesity prevention interventions and their intended outcomes. A systematic narrative synthesis review was conducted of published community-based obesity prevention interventions to identify factors contributing to intervention sustainability. Data extracted were included study authors' perspectives of intervention success and sustainability. Eighty-one papers met the inclusion criteria, and from these we identified ten factors that contribute to sustainability: resourcing, leadership, workforce development, community engagement, partnerships, policy, communications, adaptability, evaluation and governance. This review of community-based obesity prevention interventions gives rise to optimism that sustainable change is possible. We propose a framework to help practitioners build sustainability into their interventions and report on them so that others can also benefit.
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Affiliation(s)
- J Whelan
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Medicine
| | - P Love
- Deakin University, Geelong, Australia, School of Exercise and Nutrition Sciences
| | - L Millar
- Victoria University, Melbourne, Australia, Australian Health Policy Collaboration
| | - S Allender
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Health and Social Development
| | - C Bell
- Deakin University, Geelong, Australia, Global Obesity Centre, School of Medicine
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Razak LA, Yoong SL, Wiggers J, Morgan PJ, Jones J, Finch M, Sutherland R, Lecathelnais C, Gillham K, Clinton-McHarg T, Wolfenden L. Impact of scheduling multiple outdoor free-play periods in childcare on child moderate-to-vigorous physical activity: a cluster randomised trial. Int J Behav Nutr Phys Act 2018; 15:34. [PMID: 29615061 PMCID: PMC5883422 DOI: 10.1186/s12966-018-0665-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Increasing the frequency of periods of outdoor free-play in childcare may represent an opportunity to increase child physical activity. This study aimed to assess the efficacy of scheduling multiple periods of outdoor free-play in increasing the time children spend in moderate-to-vigorous physical activity (MVPA) while attending childcare. Methods The study employed a cluster randomised controlled trial design involving children aged 3 to 6 years, attending ten childcare services in the Hunter New England region of New South Wales, Australia. Five services were randomised to receive the intervention and five to a control condition. The intervention involved services scheduling three separate periods of outdoor free-play from 9 am to 3 pm per day, each at least 15 min in duration, with the total equivalent to their usual daily duration of outdoor play period. Control services implemented the usual single continuous period of outdoor free-play over this time. The primary outcome, children’s moderate-to-vigorous physical activity (MVPA) while in care per day, was measured over 5 days via accelerometers at baseline and at 3 months post baseline. Secondary outcomes included percentage of time spent in MVPA while in care per day, total physical activity while in care per day and documented child injury, a hypothesised potential unintended adverse event. Childcare services and data collectors were not blind to the experimental group allocation. Results Parents of 439 (71.6%) children attending participating childcare services consented for their child to participate in the trial. Of these, 316 (72.0%) children provided valid accelerometer data at both time points. Relative to children in control services, mean daily minutes of MVPA in care was significantly greater at follow-up among children attending intervention services (adjusted difference between groups 5.21 min, 95% CI 0.59–9.83 p = 0.03). Percentage of time spent in MVPA in care per day was also greater at follow-up among children in intervention services relative to control services (adjusted difference between groups 1.57, 95% CI 0.64–2.49 p < 0.001). Total physical activity while in care per day, assessed via counts per minute approached but did not reach significance (adjusted difference between groups 14.25, 95% CI 2.26–30.76 p = 0.09). There were no differences between groups in child injury nor subgroup interactions for the primary trial outcome by child age, sex, or baseline MVPA levels. Conclusion Scheduling multiple periods of outdoor free-play significantly increased the time children spent in MVPA while in attendance at childcare. This simple ecological intervention could be considered for broader dissemination as a strategy to increase child physical activity at a population level. Trial registration This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN1261000347460). Prospectively registered 17th March 2016. Electronic supplementary material The online version of this article (10.1186/s12966-018-0665-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lubna Abdul Razak
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Philip J Morgan
- School of Education, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
| | - Jannah Jones
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Meghan Finch
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | | | - Karen Gillham
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - Tara Clinton-McHarg
- School of Psychology, University of Newcastle, Newcastle, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, 2308, Australia
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Understanding a successful obesity prevention initiative in children under 5 from a systems perspective. PLoS One 2018; 13:e0195141. [PMID: 29596488 PMCID: PMC5875853 DOI: 10.1371/journal.pone.0195141] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 03/16/2018] [Indexed: 01/19/2023] Open
Abstract
Introduction/Background Systems thinking represents an innovative and logical approach to understanding complexity in community-based obesity prevention interventions. We report on an approach to apply systems thinking to understand the complexity of a successful obesity prevention intervention in early childhood (children aged up to 5 years) conducted in a regional city in Victoria, Australia. Methods A causal loop diagram (CLD) was developed to represent system elements related to a successful childhood obesity prevention intervention in early childhood. Key stakeholder interviews (n = 16) were examined retrospectively to generate purposive text data, create microstructures, and form a CLD. Results A CLD representing key stakeholder perceptions of a successful intervention comprised six key feedback loops explaining changes in project implementation over time. The loops described the dynamics of collaboration, network formation, community awareness, human resources, project clarity, and innovation. Conclusion The CLD developed provides a replicable means to capture, evaluate and disseminate a description of the dynamic elements of a successful obesity prevention intervention in early childhood.
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McSweeney L, Araújo-Soares V, Rapley T, Adamson A. A feasibility study with process evaluation of a preschool intervention to improve child and family lifestyle behaviours. BMC Public Health 2017; 17:248. [PMID: 28284191 PMCID: PMC5346247 DOI: 10.1186/s12889-017-4167-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 03/03/2017] [Indexed: 11/29/2022] Open
Abstract
Background Around a fifth of children starting school in England are now overweight/obese. There is a paucity of interventions with the aim of obesity prevention in preschool-age children in the UK. Previous research has demonstrated some positive results in changing specific health behaviours, however, positive trends in overall obesity rates are lacking. Preschool settings may provide valuable opportunities to access children and their families not only for promoting healthy lifestyles, but also to develop and evaluate behaviour-change interventions. Methods This paper presents a cluster randomised feasibility study of a theory based behaviour-change preschool practitioner-led intervention tested in four preschool centres in the North East of England. The primary outcome measures were to test the acceptability and feasibility of the data collection measures and intervention. Secondary measures were collected and reported for extra information. At baseline and post intervention, children’s anthropometric, dietary and physical activity measures as well as family ‘active’ time data were collected. The preschool practitioner-led intervention included family intervention tasks such as ‘family goal-setting activities’ and ‘cooking challenges’. Preschool activities included increasing physical activity and providing activities with the potential to change behaviour with increased knowledge of and acceptance of healthy eating. The process evaluation was an on-going monthly process and was collected in multiple forms such as questionnaires, photographs and verbal feedback. Results ‘Gatekeeper’ permission and lower-hierarchal adherence were initially a problem for recruitment and methods acceptance. However, at intervention end the preschool teachers and parents stated they found most intervention methods and activities acceptable, and some positive changes in family health behaviours were reported. However, the preschool centres appeared to have difficulties with enforcing everyday school healthy eating policies. Conclusions The findings from the current study may have implications for nursery practitioners, nursery settings, Local Educational Authorities and policy makers, and contributes to the body of literature. However, further work with preschool practitioners is required to determine how personal attitudes and school policy application can be supported to implement successfully such an intervention. Trial registration ISRCTN12345678 (16/02/17) retrospectively registered.
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Affiliation(s)
- Lorraine McSweeney
- Institute of Health and Society and Human Nutrition Research Centre, Newcastle University, Framlington Place, Newcastle, NE2 4HH, UK.
| | - Vera Araújo-Soares
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle, NE2 4AX, UK
| | - Tim Rapley
- Institute of Health & Society, Newcastle University, Richardson Road, Newcastle, NE2 4AX, UK
| | - Ashley Adamson
- Institute of Health and Society and Human Nutrition Research Centre, Newcastle University, Framlington Place, Newcastle, NE2 4HH, UK
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Wolfenden L, Jones J, Williams CM, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Wiggers J, Williams AJ, Seward K, Small T, Welch V, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2016; 10:CD011779. [PMID: 27699761 PMCID: PMC6458009 DOI: 10.1002/14651858.cd011779.pub2] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. SEARCH METHODS We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. DATA COLLECTION AND ANALYSIS The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. AUTHORS' CONCLUSIONS Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.
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Affiliation(s)
| | | | | | | | | | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | | | | | | | | | - Vivian Welch
- University of OttawaBruyère Research Institute85 Primrose StreetOttawaCanadaK1N 5C8
| | - Debbie Booth
- University of NewcastleUniversity LibraryUniversity DriveCallaghanAustralia2308
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13
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Yoong SL, Finch M, Nathan N, Wiggers J, Lecathelinais C, Jones J, Dodds P, Wolfenden L. A longitudinal study assessing childcare services' adoption of obesity prevention policies and practices. J Paediatr Child Health 2016; 52:765-70. [PMID: 27244222 DOI: 10.1111/jpc.13252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 12/18/2022]
Abstract
AIM Despite ongoing investments to improve the obesogenic environments of childcare settings, little is known regarding how these services have changed their physical activity and nutrition-promoting practices. This study aims to describe changes in the proportion of Australian childcare services that have adopted best-practice healthy eating and physical activity practices between 2006 and 2013 and to assess whether adoption varied by socio-economic status and locality. METHODS A randomly selected sample of nominated supervisors (n = 358) from childcare services located in New South Wales, Australia, participated in a telephone survey in 2006, 2009, 2010 and 2013. Supervisors reported on their service's adoption of six practices: (i) having written nutrition and physical activity policies; (ii) staff trained in physical activity and nutrition in the past year; (iii) scheduled time for fundamental movement skills and (iv) outdoor play; (v) weekly or less screen time opportunities; and (vi) serving only non-sweetened beverages. RESULTS A significant increase in the prevalence of services adopting all but one practice, between 2006 and 2013 was identified. Ninety one percent of services adopted four or more practices, a significant increase from 38% in 2006. There were no differences in the proportion of services adopting each practice by locality and socio-economic status. CONCLUSIONS Government investment in obesity prevention programmes can equitably improve childcare service's adoption of healthy eating and physical activity promoting practices on a jurisdiction-wide basis. The establishment of a routine system to monitor adoption of a broader range of practices by childcare services is warranted.
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Affiliation(s)
- Sze Lin Yoong
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Meghan Finch
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Jannah Jones
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Pennie Dodds
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, New South Wales, Australia
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Obesity prevention and obesogenic behavior interventions in child care: A systematic review. Prev Med 2016; 87:57-69. [PMID: 26876631 DOI: 10.1016/j.ypmed.2016.02.016] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/26/2016] [Accepted: 02/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Review peer-reviewed interventions designed to reduce obesity and improve obesogenic behaviors, including physical activity, diet, and screen time, at child care centers. Interventions components and outcomes, study design, duration, use of behavioral theory, and level of social ecological influence are detailed. METHODS Article searches were conducted from March 2014, October 2014, March 2015, January 2016 across three databases. Eligible interventions were conducted in child care settings, included 3-to-5-year-old children, included an outcome measure of obesity or obesogenic behavior, and published in English. Study design quality was assessed using Stetler's Level of Quantitative Evidence. RESULTS All unique records were screened (n=4589): 237 articles were assessed for eligibility. Of these, 97 articles describing 71 interventions met inclusion criteria. Forty-four articles included multi-level interventions. Twenty-nine interventions included an outcome measure of obesity. Forty-one interventions included physical activity. Forty-five included diet. Eight included screen time. Fifty-five percent of interventions were Level II (randomized controlled trials), while 37% were Level III (quasi-experimental or pre-post only study design), and 8% were Level IV (non-experimental or natural experiments). Most interventions had the intended effect on the target: obesity 48% (n=14), physical activity 73% (n=30), diet 87% (n=39), and screen time 63% (n=5). CONCLUSION Summarizing intervention strategies and assessing their effectiveness contributes to the existing literature and may provide direction for practitioners and researchers working with young children in child care. Most interventions produced the targeted changes in obesity and obesity-associated behaviors, supporting current and future efforts to collaborate with early-care centers and professionals for obesity prevention.
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Esquivel M, Nigg CR, Fialkowski MK, Braun KL, Li F, Novotny R. Head Start Wellness Policy Intervention in Hawaii: A Project of the Children's Healthy Living Program. Child Obes 2016; 12:26-32. [PMID: 26771119 DOI: 10.1089/chi.2015.0071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The increased prevalence of childhood overweight and obesity across the United States and the Pacific has become a serious public health concern, with especially high prevalence among Native Hawaiian and Pacific Islander (NHPI) children. This study aimed to measure the effect of a Head Start (HS) policy intervention for childhood obesity prevention. METHODS Twenty-three HS classrooms located in Hawaii participated in the trial of a 7-month policy intervention with HS teachers. Classroom- and child-level outcome assessments were conducted, including: the Environment and Policy Assessment and Observations (EPAO) of the classroom environment; plate waste observations to assess child intake of fruit and vegetables; and child growth. RESULTS The intervention showed a positive and significant effect on classroom EPAO physical activity (PA) and EPAO total scores. Although mean BMI z-score (zBMI) increased at postintervention for both intervention (mean = 0.60; standard deviation [SD], 1.16; n = 114) and delayed-intervention groups (mean = 0.35; SD, 1.17; n = 132), change in zBMI was not significantly different between the groups (p = 0.50; p = 0.48). CONCLUSIONS These findings contribute evidence on the potential for HS wellness policy to improve the PA environment of HS classrooms. More research is needed to link these policy changes to other child outcomes.
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Affiliation(s)
- Monica Esquivel
- 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI
| | - Claudio R Nigg
- 2 Office of Public Health Studies, University of Hawaii at Mānoa , Honolulu, HI
| | - Marie K Fialkowski
- 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI
| | - Kathryn L Braun
- 2 Office of Public Health Studies, University of Hawaii at Mānoa , Honolulu, HI
| | - Fenfang Li
- 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI
| | - Rachel Novotny
- 1 Department of Human Nutrition, Food, and Animal Sciences, University of Hawaii at Mānoa , Honolulu, HI
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Joseph S, Stevens AM, Ledoux T, O'Connor TM, O'Connor DP, Thompson D. Rationale, Design, and Methods for Process Evaluation in the Childhood Obesity Research Demonstration Project. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:560-565.e1. [PMID: 26298514 DOI: 10.1016/j.jneb.2015.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/26/2015] [Accepted: 07/19/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The cross-site process evaluation plan for the Childhood Obesity Research Demonstration (CORD) project is described here. DESIGN The CORD project comprises 3 unique demonstration projects designed to integrate multi-level, multi-setting health care and public health interventions over a 4-year funding period. SETTING Three different communities in California, Massachusetts, and Texas. PARTICIPANTS All CORD demonstration projects targeted 2-12-year-old children whose families are eligible for benefits under Title XXI (CHIP) or Title XIX (Medicaid). INTERVENTION(S) The CORD projects were developed independently and consisted of evidence-based interventions that aim to prevent childhood obesity. The interventions promote healthy behaviors in children by applying strategies in 4 key settings (primary care clinics, early care and education centers, public schools, and community institutions). MAIN OUTCOME MEASURE(S) The CORD process evaluation outlined 3 main outcome measures: reach, dose, and fidelity, on 2 levels (researcher to provider, and provider to participant). ANALYSIS The plan described here provides insight into the complex nature of process evaluation for consortia of independently designed multi-level, multi-setting intervention studies. The process evaluation results will provide contextual information about intervention implementation and delivery with which to interpret other aspects of the program.
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Affiliation(s)
- Sitara Joseph
- Center on Research and Evaluation, Simmons School of Education and Human Development, Southern Methodist University, Dallas, TX
| | - Andria M Stevens
- Texas Obesity Research Center, University of Houston, Houston, TX
| | - Tracey Ledoux
- Texas Obesity Research Center, University of Houston, Houston, TX
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | | | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX.
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Peñalvo JL, Sotos-Prieto M, Santos-Beneit G, Pocock S, Redondo J, Fuster V. The Program SI! intervention for enhancing a healthy lifestyle in preschoolers: first results from a cluster randomized trial. BMC Public Health 2013; 13:1208. [PMID: 24359285 PMCID: PMC3901339 DOI: 10.1186/1471-2458-13-1208] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/16/2013] [Indexed: 11/20/2022] Open
Abstract
Background Unhealthy lifestyles contribute to the development of cardiovascular risk factors, whose incidence is increasing among children and adolescents. The Program SI! is a long-term, multi-target behavioral intervention to promote healthy lifestyle habits in children through the school environment. The objective of the study is to evaluate the efficacy of this intervention in its first phase, preschoolers. Methods Cluster-randomized controlled trial in public schools in the city of Madrid, Spain. A total 24 schools, including 2062 children (3–5 years), 1949 families, and 125 teachers participated in the study. Schools were assigned to their usual school curriculum or to engage in an additional multi-component intervention (Program SI!). The primary outcome of this trial is 1-school year changes from baseline in scores for children’s knowledge, attitudes and habits (KAH). Secondary outcomes are 1-school year changes from baseline in scores for knowledge, attitudes, and habits among parents, teachers, and the school environment. Results After 1-school year, our results indicate that the Program SI! intervention increases children’s KAH scores, both overall (3.45, 95% CI, 1.84-5.05) and component-specific (Diet: 0.93, 95% CI, 0.12-1.75; Physical activity: 1.93, 95% CI, 1.17-2.69; Human body: 0.65, 95% CI, 0.07-1.24) score. Conclusions The Program SI! is demonstrated as an effective and feasible strategy for increasing knowledge and improving lifestyle attitudes and habits among very young children. Trial registration NCT01579708, Evaluation of the Program SI! for Preschool Education: A School-Based Randomized Controlled Trial (Preschool-SI!).
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Affiliation(s)
- José L Peñalvo
- Area of Epidemiology and Populations Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fdez Almagro 3, Madrid 28029, Spain.
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