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Carducci B, Dominguez G, Kidd E, Oh C, Jain R, Khan A, Bhutta ZA. Promoting healthy school food environments and nutrition in Canada: a systematic review of interventions, policies, and programs. Nutr Rev 2024:nuae030. [PMID: 38767979 DOI: 10.1093/nutrit/nuae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
CONTEXT The school food environment is a critical interface for child and adolescent nutrition, and there is a need to understand existing literature on Canadian school food environments to identify equity gaps and opportunities, and empower decision-makers to plan for future action. OBJECTIVE Literature on Canadian school food and nutrition interventions, policies, programs, and their effects on diets and nutritional status are synthesized and appraised in this systematic review. DATA SOURCES A search strategy was developed for each database used (Medline, Embase, PsycINFO, ERIC, Cochrane Collaboration, Canadian Electronic Library, BiblioMap), with a combination of free text and controlled vocabulary, for articles published from 1990 to 2021. Unpublished data and grey literature were also searched. DATA EXTRACTION Quantitative and qualitative studies with an observational or intervention study design, reviews, or program evaluations conducted in Canadian schools with participants aged 5-19.9 years were included. Key study characteristics and risk of bias were extracted independently by 2 investigators using a standardized tool. DATA ANALYSIS A total of 298 articles were included (n = 192 peer reviewed and 106 from the grey literature), which were mostly conducted in Ontario (n = 52), British Columbia (n = 43), and Nova Scotia (n = 28). Twenty-four interventions, 5 nonevaluated programs, and 1 policy involved Indigenous populations. Overall, 86 articles measured and reported on effectiveness outcomes, including dietary intake; anthropometry; knowledge, attitudes, and practices; and physical activity. The literature remains largely heterogenous and primarily focused on nutrition education programs that use subjective assessments to infer changes in nutrition. A key facilitator to implementation and sustainability was community engagement, whereas key barriers were staff capacity, access to resources and funding, and consistent leadership. CONCLUSIONS This review provides insight into Canadian school food and nutrition interventions, programs, and policies and uncovers important evidence gaps that require careful examination for future evaluations. Governments must create supportive environments that optimize nutrition for children and adolescents through equitable policies and programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022303255.
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Affiliation(s)
- Bianca Carducci
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Georgia Dominguez
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Emily Kidd
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Christina Oh
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Reena Jain
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
| | - Amira Khan
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Peter Gilgan Centre for Research, and Learning, Toronto, ON, Canada
- Department of Nutritional Sciences, University of Toronto, Faculty of Medicine, University of Toronto, Medical Sciences Building, Toronto, ON, Canada
- Centre of Excellence in Women, and Child Health, Aga Khan University, Karachi, Pakistan
- Dalla Lana School of Public, Health University of Toronto Health Sciences Building, Toronto, ON, Canada
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Wilcox H, Bishop S, Francis B, Lombard K, Beresford SAA, Ornelas IJ. Process evaluation of the Yéego! Program to increase healthy eating and gardening among American Indian elementary school children. BMC Public Health 2024; 24:232. [PMID: 38243203 PMCID: PMC10797868 DOI: 10.1186/s12889-024-17689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND American Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden. METHODS Our process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes. RESULTS We identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards. CONCLUSIONS The program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.
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Affiliation(s)
- Heather Wilcox
- University of Washington, Box 351621, Seattle, WA, 98195, USA
| | - Sonia Bishop
- Fred Hutchinson Cancer Research Center, Seattle, USA
| | | | | | | | - India J Ornelas
- University of Washington, Box 351621, Seattle, WA, 98195, USA.
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Bonin L, Levasseur-Puhach S, Guimond M, Gabbs M, Wicklow B, Vandenbroeck B, Copenace S, Delaronde M, Mosienko L, McGavock J, Katz LY, Roos LE, Diffey L, Dart A. Walking in two worlds with type 2 diabetes: a scoping review of prevention and management practices incorporating traditional indigenous approaches. Int J Circumpolar Health 2022; 81:2141182. [DOI: 10.1080/22423982.2022.2141182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lynette Bonin
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Sydney Levasseur-Puhach
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Michelle Guimond
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Gabbs
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Belinda Vandenbroeck
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Sherry Copenace
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
| | - Meagan Delaronde
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Lucas Mosienko
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
| | - Laurence Y. Katz
- University of Manitoba, Max Rady College of Medicine, Department of Psychiatry, Winnipeg, Manitoba, Canada
| | - Leslie E. Roos
- University of Manitoba, Faculty of Arts, Department of Psychology Winnipeg, Manitoba Canada
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Diffey
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Community Health Sciences, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Children’s Hospital Research Institute of Manitoba, and DREAM Theme, Diabetes Research Envisioned and Accomplished in Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba, Max Rady College of Medicine, Department of Pediatric and Child Health, Winnipeg, Manitoba, Canada
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The essential conditions needed to implement the Indigenous Youth Mentorship Program: a focused ethnography. BMC Public Health 2022; 22:213. [PMID: 35105323 PMCID: PMC8808991 DOI: 10.1186/s12889-021-12412-1] [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: 06/18/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Indigenous Youth Mentorship Program (IYMP) is a 20-week communal, relationship-based afterschool healthy living program for Indigenous youth in Canada. IYMP embraces the Anishnaabe/Nehiyawak concepts of Mino-Bimaadiziwin/miyo-pimâtisiwin (“living in a good way”) via its core components of physical activities/games, healthy snacks, and relationship-building. A strength of IYMP is that it values autonomy, adaptability, and the school community context. However, this presents challenges when evaluating its implementation, given that traditional implementation science methods tend to oversimplify the process. In response, essential conditions for the implementation of school-based healthy living programs across diverse contexts have been developed. The purpose of this research was to understand the applicability of these essential conditions within the context of IYMP. Methods 15 participants (n = 10 Young Adult Health Leaders; n = 5 coordinators) with experience implementing IYMP in the provinces of Alberta, Saskatchewan, Manitoba, and Quebec were purposefully sampled. Focused ethnography was the guiding method and one-on-one semi-structured interviews were used as the data generation strategy. The purpose of the interviews was to understand what conditions are needed to implement IYMP. The interview guide was based on previously established essential conditions developed by the research team. Interviews were audio-recorded and transcribed, and content analysis was used to identify patterns in the data. Results The overarching theme that emerged from the interviews was the applicability of the essential conditions when implementing IYMP. Participants felt the eight core conditions (students as change agents, school/community-specific autonomy, demonstrated administrative leadership, higher-level support, dedicated champion(s) to engage school community, community support, quality and use of evidence, and professional development) and four contextual conditions (time, funding and project support, readiness and understanding, and prior community connectivity) were necessary, but made suggestions to modify two conditions (youth led and learning opportunities) to better reflect their experiences implementing IYMP. In addition, a new core condition, rooted in relationship, emerged as necessary for implementation. Conclusions This research adds to the literature by identifying and describing what is needed in practice to implement a communal, relationship-based afterschool healthy living program. The essential conditions may support other researchers and communities interested in implementing and rippling similar programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12412-1.
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Getachew-Smith H, King AJ, Marshall C, Scherr CL. Process Evaluation in Health Communication Media Campaigns: A Systematic Review. Am J Health Promot 2021; 36:367-378. [PMID: 34878312 DOI: 10.1177/08901171211052279] [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
Objective. The objective is to examine the scope of health communication media campaign process evaluation methods, findings, and dissemination practices. Data Source. A systematic review of peer-reviewed literature was conducted using database searches. Study Inclusion and Exclusion Criteria. Published studies on process and implementation evaluation of health campaigns with a media component were included. Exclusion criteria included not health, non-empirical, no media campaign, or a focus on other evaluation types. Data Extraction. Articles were assessed for general campaign information, theory use, and details about process evaluation plan and procedures. Data Synthesis. A coding scheme based on 9 process evaluation best practice elements (e.g., fidelity and context) was applied. Process evaluation methods, measures, and reporting themes were synthesized. Results. Among 691 unique records, 46 articles were included. Process evaluation was the main focus for 71.7% of articles, yet only 39.1% reported how process evaluation informed campaign implementation strategy. Articles reported 4.39 elements on average (SD = 1.99; range 1-9), with reach (87.0%) and recruitment (73.9%) described most frequently, yet reporting was inconsistent. Further, the level of detail in reporting methods, theory, and analysis varied. Conclusions. Process evaluation provides insight about mechanisms and intervening variables that could meaningfully impact interpretations of outcome evaluations; however, process evaluations are less often included in literature. Recommendations for evidence-based process evaluation components to guide evaluation are discussed.
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Affiliation(s)
| | - Andy J King
- Greenlee School of Journalism & Communication, 1177Iowa State University, Ames, IA, USA
| | - Charlotte Marshall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 25798Emory University, Atlanta, GA, USA
| | - Courtney L Scherr
- Department of Communication Studies, 3270Northwestern University, Evanston, IL, USA
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Chando S, Howell M, Young C, Craig JC, Eades SJ, Dickson M, Howard K. Outcomes reported in evaluations of programs designed to improve health in Indigenous people. Health Serv Res 2021; 56:1114-1125. [PMID: 33748978 PMCID: PMC8586489 DOI: 10.1111/1475-6773.13653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the outcomes reported and measured in evaluations of complex health interventions in Indigenous communities. DATA SOURCES We searched all publications indexed in MEDLINE, PreMEDLINE, EMBASE, PsycINFO, EconLit, and CINAHL until January 2020 and reference lists from included papers were hand-searched for additional articles. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS We included all primary studies, published in peer-reviewed journals, where the main objective was to evaluate a complex health intervention developed specifically for an Indigenous community residing in a high-income country. Only studies published in English were included. Quantitative and qualitative data were extracted and summarized. PRINCIPAL FINDINGS Of the 3523 publications retrieved, 62 evaluation studies were included from Australia, the United States, Canada, and New Zealand. Most studies involved less than 100 participants and were mainly adults. We identified outcomes across 13 domains: clinical, behavioral, process-related, economic, quality of life, knowledge/awareness, social, empowerment, access, environmental, attitude, trust, and community. Evaluations using quantitative methods primarily measured outcomes from the clinical and behavioral domains, while the outcomes reported in the qualitative studies were mostly from the process-related and empowerment domains. CONCLUSION The outcomes from qualitative evaluations, which better reflect the impact of the intervention on participant health, remain different from the outcomes routinely measured in quantitative evaluations. Measuring the outcomes from qualitative evaluations alongside outcomes from quantitative evaluations could result in more relevant evaluations to inform decision making in Indigenous health.
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Affiliation(s)
- Shingisai Chando
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Martin Howell
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | | | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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Estradé M, van Dongen EJI, Trude ACB, Poirier L, Fleischhacker S, Wensel CR, Redmond LC, Pardilla M, Swartz J, Treuth MS, Gittelsohn J. Exposure to a Multilevel, Multicomponent Obesity Prevention Intervention (OPREVENT2) in Rural Native American Communities: Variability and Association with Change in Diet Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212128. [PMID: 34831884 PMCID: PMC8621011 DOI: 10.3390/ijerph182212128] [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] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
The OPREVENT2 obesity prevention trial was a multilevel multicomponent (MLMC) intervention implemented in rural Native American communities in the Midwest and Southwest U.S. Intervention components were delivered through local food stores, worksites, schools, community action coalitions, and by social and community media. Due to the complex nature of MLMC intervention trials, it is useful to assess participants’ exposure to each component of the intervention in order to assess impact. In this paper, we present a detailed methodology for evaluating participant exposure to MLMC intervention, and we explore how exposure to the OPREVENT2 trial impacted participant diet quality. There were no significant differences in total exposure score by age group, sex, or geographic region, but exposure to sub-components of the intervention differed significantly by age group, sex, and geographical region. Participants with the highest overall exposure scores showed significantly more improvement in diet quality from baseline to follow up compared to those who were least exposed to the intervention. Improved diet quality was also significantly positively associated with several exposure sub-components. While evaluating exposure to an entire MLMC intervention is complex and imperfect, it can provide useful insight into an intervention’s impact on key outcome measures, and it can help identify which components of the intervention were most effective.
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Affiliation(s)
- Michelle Estradé
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
- Correspondence: (M.E.); (E.J.I.v.D.)
| | - Ellen J. I. van Dongen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
- Correspondence: (M.E.); (E.J.I.v.D.)
| | - Angela C. B. Trude
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Lisa Poirier
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | | | - Caroline R. Wensel
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | - Leslie C. Redmond
- School of Allied Health, University of Alaska Anchorage, Anchorage, AK 99508, USA;
| | - Marla Pardilla
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | - Jacqueline Swartz
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | - Margarita S. Treuth
- Department of Kinesiology, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Princess Anne, MD 21853, USA;
| | - Joel Gittelsohn
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
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Nelson C, Madiba S. Barriers to the Implementation of the Ward-Based Outreach Team Program in Mpumalanga Province: Results From Process Evaluation. J Prim Care Community Health 2021; 11:2150132720975552. [PMID: 33213270 PMCID: PMC7682205 DOI: 10.1177/2150132720975552] [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] [Indexed: 11/22/2022] Open
Abstract
Background: South Africa adopted the ward-based outreach team (WBOT) program as one aspect of the three-stream approach to primary health care (PHC) re-engineering. PHC re-engineering seeks to modify the hospicentric and curative approach into a more preventive and promotive approach to improve health outcomes. There has not been an evaluation of the implementation of the WBOTs in Nkangala District since its inception in 2012. Methods: A process evaluation approach using qualitative methods was used to examine and describe the contextual, organizational, health provider, and program-related barriers considered to affect the implementation of the WBOTs 3 sub-districts in one of the health districts in Mpumalanga Province, South Africa. The framework for this evaluation was informed by the logic model framework developed by the Center for Disease Control as well as the 3 domains of evaluation recommended by the Medical Research Council Guidance on process evaluation. Data were collected through in-depth interviews with multiple data sources directly involved in the implementation of the WBOTs. A thematic analysis was done using NVivo 11. Results: The key critical barriers identified by the evaluation include the inadequate provision of resources, the lack of supervision, the heavy workload for outreach teams, the inadequate and irregular payment of stipends, threats to the safety of the CHWs, and the cultural beliefs and practices of the communities who are to receive the services. The lack of adequate financial resources was the main challenge, and will continue to pose a risk to the successful implementation of the WBOTs. Conclusions: Although the barriers are being reported as separate contextual factors, the internal and external contexts are interdependent, interact with one each other, and should not be considered in isolation. The need to improve stakeholder engagement on the WBOT program underscores the importance of the external context in the successful implementation of WBOTs.
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Affiliation(s)
- Cheryl Nelson
- Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sphiwe Madiba
- Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Evaluating the implementation and impact of a healthier checkout programme at a regional convenience store chain. Public Health Nutr 2021; 24:3520-3529. [PMID: 33820587 DOI: 10.1017/s1368980021001488] [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: 11/06/2022]
Abstract
OBJECTIVE To test the feasibility of implementing and evaluating a healthier checkout pilot study in a convenience store chain. DESIGN A quasi-experimental study was conducted comparing a 3-month 'healthier checkouts' intervention in ten convenience stores which stocked eight healthier items in the checkout space and ten comparison stores assigned to continue stocking their current checkout space product mix. All aspects of the intervention were implemented by the retailer. The research team conducted in-person fidelity checks to assess implementation. Sales data were collected from the retailer in order to compare mean baseline to intervention sales of the eight healthier items in intervention and comparison groups while controlling for overall store sales. SETTING Convenience store chain. PARTICIPANTS Twenty convenience stores in New Hampshire. RESULTS The increases in sales of healthier items between the baseline and intervention periods among the intervention and comparison stores were not statistically significant; however, the overall pattern of the results showed promising changes that should be expanded on in future studies. Intervention fidelity checks indicated that results may have been attenuated by variability in intervention implementation. CONCLUSIONS This study advances the evidence for effective promotion of healthier food purchases in the convenience store chain setting and adds to the current literature on retail checkout space interventions. Additional research is needed to confirm and expand these results.
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Chando S, Tong A, Howell M, Dickson M, Craig JC, DeLacy J, Eades SJ, Howard K. Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies. Health Expect 2021; 24:731-743. [PMID: 33729648 PMCID: PMC8235882 DOI: 10.1111/hex.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Aim To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes. Methods We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles. Results From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability. Conclusion The prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities. Patient or public contribution This paper is a review of evaluation studies and did not involve patients or the public.
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Affiliation(s)
- Shingisai Chando
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jack DeLacy
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Kenny TA, Little M, Lemieux T, Griffin PJ, Wesche SD, Ota Y, Batal M, Chan HM, Lemire M. The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238818. [PMID: 33261090 PMCID: PMC7730644 DOI: 10.3390/ijerph17238818] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.
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Affiliation(s)
- Tiff-Annie Kenny
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, QC G1V 0A6, Canada;
- Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC G1E 6W2, Canada
- Correspondence: or
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Tad Lemieux
- Department of English Language and Literature, Carleton University, Ottawa, ON K1S 5B6, Canada;
| | - P. Joshua Griffin
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA; (P.J.G.); (Y.O.)
- Department of American Indian Studies, University of Washington, Seattle, WA 98195, USA
| | - Sonia D. Wesche
- Department of Geography, Environment and Geomatics, Faculty of Arts, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Yoshitaka Ota
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA; (P.J.G.); (Y.O.)
- Nippon Foundation Ocean Nexus Center, EarthLab, University of Washington; Seattle, WA 98195, USA
| | - Malek Batal
- Département de nutrition, Faculté de médecine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, QC H3N 1X9, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, Ottawa, ON K1N 9A7, Canada;
| | - Melanie Lemire
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, QC G1V 0A6, Canada;
- Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC G1E 6W2, Canada
- Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Quebec, QC G1V 0A6, Canada
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Nelson C, Madiba S. The Perspectives of Programme Staff and Recipients on the Acceptability and Benefits of the Ward-Based Outreach Teams in a South African Province. Healthcare (Basel) 2020; 8:healthcare8040464. [PMID: 33167601 PMCID: PMC7712545 DOI: 10.3390/healthcare8040464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/22/2022] Open
Abstract
The re-engineering of primary health care (PHC) called for the establishment of ward-based outreach teams as a reform strategy to bridge the gap between health facilities and communities. The Nkangala district established ward-based outreach teams in 2012. We used process evaluation to assess the acceptability of the outreach teams from the perspectives of those involved in the implementation as well as the clients who are the recipients of the outreach services in order to describe how the programme benefits the recipients, the staff, and the health system. Data were collected through interviews with multiple data sources. A thematic analysis was done using NVivo 11. The outreach programme is acceptable to the recipients and staff. The acceptability translated into measurable benefits for the recipients and the health system. Health benefits included increased access to services, support for treatment adherence, and linkages to various sector departments for social support. Since the inception of outreach teams, the district has recorded low utilisation of PHC services and improved priority indicators such as immunisation coverage, early antenatal bookings, treatment adherence, TB cure rates, and decreased default rates. The positive effects of the outreach teams on indicators underscore the need to roll the programme out to all sub-districts.
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Vaz LME, Franco L, Guenther T, Simmons K, Herrera S, Wall SN. Operationalising health systems thinking: a pathway to high effective coverage. Health Res Policy Syst 2020; 18:132. [PMID: 33143734 PMCID: PMC7641804 DOI: 10.1186/s12961-020-00615-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 08/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.
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Affiliation(s)
- Lara M E Vaz
- Population Reference Bureau, 1875 Connecticut Avenue, NW Suite 520, Washington, DC, 20009, United States of America.
| | - Lynne Franco
- EnCompass LLC, 1451 Rockville Pike Suite 600, Rockville, MD, 20852, USA
| | - Tanya Guenther
- Formerly with Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Kelsey Simmons
- Ford Foundation, 320 E 43rd St, New York, NY, 10017, USA
| | - Samantha Herrera
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
| | - Stephen N Wall
- Save the Children US, 899 North Capitol St NE Suite 900, Washington DC, 20001, USA
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14
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Gittelsohn J, Jock B, Poirier L, Wensel C, Pardilla M, Fleischhacker S, Bleich S, Swartz J, Trude ACB. Implementation of a multilevel, multicomponent intervention for obesity control in Native American communities (OPREVENT2): challenges and lessons learned. HEALTH EDUCATION RESEARCH 2020; 35:228-242. [PMID: 32413105 PMCID: PMC7243725 DOI: 10.1093/her/cyaa012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/20/2020] [Indexed: 05/03/2023]
Abstract
OPREVENT2 was a multilevel, multicomponent (MLMC) adult obesity prevention that sought to improve access and demand for healthier food and physical activity opportunities in six Native American communities in the Southwest and Midwest. OPREVENT2 worked with worksites, food stores, schools (grades 2-6), through social media and mailings, and with a local community action committee (CAC), in each of the three intervention communities, and was implemented in six phases. We conducted a process evaluation to assess implementation of each intervention component in terms of reach, dose delivered and fidelity. Implementation of each component was classified as high, medium or low according to set standards, and reported back at the end of each phase, allowing for improvements. The school and worksite components were implemented with high reach, dose delivered and fidelity, with improvement over time. The school program had only moderate reach and dose delivered, as did the social media component. The CAC achieved high reach and dose delivered. Overall, study reach and dose delivered reached a high implementation level, whereas fidelity was medium. Great challenges exist in the consistent implementation of MLMC interventions. The detailed process evaluation of the OPREVENT2 trial allowed us to carefully assess the relative strengths and limitations of each intervention component.
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Affiliation(s)
- J Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - B Jock
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - L Poirier
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - C Wensel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - M Pardilla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - S Bleich
- Department of Health Policy and Management, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - J Swartz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Angela C B Trude
- Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
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15
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Gillies C, Blanchet R, Gokiert R, Farmer A, Thorlakson J, Hamonic L, Willows ND. School-based nutrition interventions for Indigenous children in Canada: a scoping review. BMC Public Health 2020; 20:11. [PMID: 31906984 PMCID: PMC6945607 DOI: 10.1186/s12889-019-8120-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Indigenous children in Canada (First Nations, Inuit, and Métis) are disproportionately affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions offer a promising strategy for improving children’s access to healthy foods and sustaining positive eating behaviors. However, little is known about school-based nutrition interventions for Indigenous children. The objectives of this scoping review were to identify school-based nutrition interventions for Indigenous children in Canada and describe their components. Methods The scoping review consisted of searches in seven peer-reviewed databases and a general web search for grey literature. Eligibility criteria were applied by two reviewers, and data were extracted and charted by one reviewer using components of the comprehensive school health approach (social and physical environment, teaching and learning, policy, partnerships and services) and additional components with relevance to Indigenous interventions (cultural content, Indigenous control and ownership, funding source, evaluation). Numerical and descriptive summaries were used to present findings. Results Thirty-four unique interventions met the inclusion criteria. The majority (97%) of interventions targeted the social and physical environment, most often by offering food programs. Over half of interventions also incorporated teaching and learning (56%) and partnerships and services (59%), but fewer included a policy component (38%). Many interventions included a cultural component (56%) and most (62%) were owned and controlled by Indigenous communities (62%). Finally, over half of interventions disclosed their source(s) of funding (59%), but less than half (41%) included an evaluation component. Conclusions The review suggests that school-based interventions for Indigenous children can be more comprehensive by incorporating culturally relevant nutrition education and professional development opportunities for teachers, written school nutrition policies, and activities that actively engage families and community members. The continued focus on Indigenous control and ownership and incorporation of content specific to individual communities may enhance cultural relevancy and sustainability of interventions. Furthermore, there is a need to increase intervention evaluation and the sharing of resources related to funding. These recommendations may be used by communities, as well as by researchers and professionals working with communities, in developing comprehensive school-based nutrition interventions to improve the eating behaviors of Indigenous children.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada
| | - Anna Farmer
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Jessica Thorlakson
- University of Alberta Library, University of Alberta, Edmonton, AB, Canada
| | - Laura Hamonic
- University of Alberta Library, University of Alberta, Edmonton, AB, Canada
| | - Noreen D Willows
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada.
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16
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Taniguchi TE, Salvatore AL, Williams MB, Love CV, Noonan CJ, Cannady TK, Standridge J, Fox J, Spiegel J, Owens J, Grammar M, Wiley A, Jernigan VBB. Process Evaluation Tool Development and Fidelity of Healthy Retail Interventions in American Indian Tribally Owned Convenience Stores: the Tribal Health Resilience in Vulnerable Environments (THRIVE) Study. Curr Dev Nutr 2020; 4:33-41. [PMID: 32258997 PMCID: PMC7101486 DOI: 10.1093/cdn/nzz073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/16/2019] [Accepted: 06/17/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Tribal Health Resilience in Vulnerable Environments (THRIVE) study aimed to increase healthy food access in 2 rural American Indian communities. The intervention sought to increase fruit and vegetable availability, variety, and convenience through placement, promotion, and pricing of healthy foods and beverages in tribal convenience stores. OBJECTIVE The aim of this study was to describe the development and implementation of the study process evaluation tool to assess intervention fidelity as part of this cluster-controlled trial. METHODS Eight stores (2 intervention and 2 control stores per Nation) participated in the study, implemented from May 2016 to May 2017. A web-based survey tailored to store layouts and intervention components assessed how often intervention items were available, approximate quantity available, and whether placement of healthier food items and promotional materials were implemented as designed. After pilot testing the survey, tribal staff members implemented it to collect process evaluation data in the 8 stores during a period of 9-12 mo, assessing study implementation and potential changes in control stores. RESULTS Promotional materials were available ≥75% of the time for most intervention locations. Fruit availability was similar in Nation A and Nation B intervention stores (79-100% compared with 70-100%), whereas fresh vegetable availability was higher in Nation B compared with Nation A (95-96% compared with 55-75%). Both control stores in Nation A and 1 control store in Nation B had moderate fruit and vegetable availability, ranging from 45% to 52%. No control stores in either Nation used intervention promotional materials. CONCLUSIONS Process evaluation data indicate that the study was implemented with moderate to high fidelity. The development and implementation of the tool can inform future healthy retail interventions that aim to improve rural and tribal food environments.
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Affiliation(s)
- Tori E Taniguchi
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Alicia L Salvatore
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center College of Public Health, Oklahoma City, OK, USA
| | - Mary B Williams
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center College of Public Health, Oklahoma City, OK, USA
| | - Charlotte V Love
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Carolyn J Noonan
- Initiative for Research and Education to Advance Community Health, Washington State University, Pullman, WA, USA
| | - Tamela K Cannady
- Choctaw Nation of Oklahoma Health Services Authority, Durant, OK, USA
| | - Joy Standridge
- Chickasaw Nation Nutrition Services Department, Purcell, OK, USA
| | - Jill Fox
- Chickasaw Nation Nutrition Services Department, Purcell, OK, USA
| | - Jennifer Spiegel
- Chickasaw Nation Nutrition Services Department, Purcell, OK, USA
| | - JoAnna Owens
- Chickasaw Nation Nutrition Services Department, Purcell, OK, USA
| | - Mandy Grammar
- Choctaw Nation of Oklahoma Health Services Authority, Durant, OK, USA
| | - AnDina Wiley
- Chickasaw Nation Nutrition Services Department, Purcell, OK, USA
| | - Valarie Blue Bird Jernigan
- Center for Indigenous Health Research and Policy, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Middel CNH, Schuitmaker-Warnaar TJ, Mackenbach JD, Broerse JEW. Systematic review: a systems innovation perspective on barriers and facilitators for the implementation of healthy food-store interventions. Int J Behav Nutr Phys Act 2019; 16:108. [PMID: 31752885 PMCID: PMC6868845 DOI: 10.1186/s12966-019-0867-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Due to their central position in the modern food system, food stores present a unique opportunity to promote healthy dietary behaviour. However, there is a lack of insight into the factors that impede or enhance the implementation of nutritional interventions in food stores. We applied a systems innovation and implementation science framework to the identification of such barriers and facilitators. METHODS We conducted a systematic literature review. A search string was developed to identify qualitative and quantitative articles on environmental nutritional interventions in the food store. Four databases were systematically searched for studies published between 2000 and 2018. Eligible publications described study designs or original studies, focused on stimulating healthier dietary behaviour through environmental changes in retail settings and contained information on the perceptions or experiences of retailers or interventionists regarding the implementation process of the intervention. Context-descriptive data was extracted and a quality assessment was performed. RESULTS We included 41 articles, of which the majority was conducted in the USA and involved single stores or a mix of single and multi-store organisations. We categorized barriers and facilitators into 18 themes, under five domains. In the 'outer setting' domain, most factors related to consumers' preferences and demands, and the challenge of establishing a supply of healthy products. In the 'inner setting' domain, these related to conflicting values regarding health promotion and commercial viability, store lay-out, (insufficient) knowledge and work capacity, and routines regarding waste avoidance and product stocking. In the 'actors' domain, no major themes were found. For the 'intervention 'domain', most related to intervention-context fit, money and resource provision, material quality, and the trade-offs between commercial costs and risks versus commercial and health benefits. For the 'process' domain, most factors related to continuous engagement and strong relationships. CONCLUSIONS This review provides a comprehensive overview of barriers and facilitators to be taken into account when implementing nutritional interventions in food stores. Furthermore, we propose a novel perspective on implementation as the alignment of intervention and retail interests, and a corresponding approach to intervention design which may help avoid barriers, and leverage facilitators. TRIAL REGISTRATION PROSPERO; CRD42018095317.
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Affiliation(s)
- Cédric N. H. Middel
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081 HV Amsterdam, Netherlands
| | | | - Joreintje D. Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, VU University Medical Center, Amsterdam, the Netherlands
| | - Jacqueline E. W. Broerse
- Athena Institute, Faculty of Science, VU University, De Boelelaan 1085, 1081 HV Amsterdam, Netherlands
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Strand MA, He M, Johnson R, Perry J, Yin Z. Process evaluation of a community-based diabetes prevention program in China: the Pathway to Health (PATH). HEALTH EDUCATION RESEARCH 2019; 34:521-531. [PMID: 31373658 DOI: 10.1093/her/cyz023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
High prevalence of diabetes and prediabetes has emerged as a concern in China. The Pathway to Health Program was designed to prevent type 2 diabetes onset in prediabetic women in a north China urban community. This process evaluation of a randomized controlled trial analysed participant surveys at the 6- and 12-month assessment times, participant weekly logs, class attendance records and post-study participant focus group results. The reported levels of participant engagement in physical activity (PA)-related behaviors were higher than diet-related behaviors at the 6-month assessment. The engagement in both PA- and diet-related behaviors declined during the 6-month follow-up period. Step counts from the participants' pedometers indicated an increase in PA in the first 6 months of the intervention. Study participants expressed high levels of satisfaction with the intervention and increased their scores on diabetes-related knowledge. Conflicts with work and family responsibilities were the main barriers for missing health lessons, likely contributing to minimal weight loss. There was good fidelity in program implementation. Intensive lifestyle modification programs are difficult to sustain once the program is complete. A more structured 6-month follow-up phase may have provided needed support to enable participants to maintain their lifestyle changes.
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Affiliation(s)
| | - Meizi He
- University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Judith Perry
- Medical Department, Shanxi Evergreen Service, Taiyuan, China
| | - Zenong Yin
- University of Texas at San Antonio, San Antonio, TX, USA
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Rowbotham S, Conte K, Hawe P. Variation in the operationalisation of dose in implementation of health promotion interventions: insights and recommendations from a scoping review. Implement Sci 2019; 14:56. [PMID: 31171008 PMCID: PMC6555031 DOI: 10.1186/s13012-019-0899-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While 'dose' is broadly understood as the 'amount' of an intervention, there is considerable variation in how this concept is defined. How we conceptualise, and subsequently measure, the dose of interventions has important implications for understanding how interventions produce their effects and are subsequently resourced and scaled up. This paper aims to explore the degree to which dose is currently understood as a distinct and well-defined implementation concept outside of clinical settings. METHODS We searched four databases (MEDLINE, PsycINFO, EBM Reviews and Global Health) to identify original research articles published between 2000 and 2015 on health promotion interventions that contained the word 'dose' or 'dosage' in the title, abstract or keywords. We identified 130 articles meeting inclusion criteria and extracted data on how dose/dosage was defined and operationalised, which we then synthesised to reveal key themes in the use of this concept across health promotion interventions. RESULTS Dose was defined in a variety of ways, including in relation to the amount of intervention delivered and/or received, the level of participation in the intervention and, in some instances, the quality of intervention delivery. We also observed some conflation of concepts that are traditionally kept separate (such as fidelity) either as slippage or as part of composite measures (such as 'intervention dose'). DISCUSSION Dose is not a well-defined or consistently applied concept in evaluations of health promotion interventions. While current approaches to conceptualisation and measurement of dose are suitable for interventions in organisational settings, they are less well suited to policies delivered at a population level. Dose often accompanies a traditional monotonic linear view of causality (e.g. dose response) which may or may not fully represent the intervention's theory of how change is brought about. Finally, we found dose and dosage to be used interchangeably. We recommend a distinction between these terms, with 'dosage' having the advantage of capturing change to amount 'dispensed' over time (in response to effects achieved). Dosage therefore acknowledges the inevitable dynamic and complexity of implementation.
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Affiliation(s)
- Samantha Rowbotham
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia. .,The Australian Prevention Partnership Centre, Sydney, Australia.
| | - Kathleen Conte
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia.,The Australian Prevention Partnership Centre, Sydney, Australia
| | - Penelope Hawe
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia.,The Australian Prevention Partnership Centre, Sydney, Australia
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Sriram U, Sandreuter K, Graham M, Folta S, Pullyblank K, Paul L, Seguin R. Process Evaluation of Strong Hearts, Healthy Communities: A Rural Community-Based Cardiovascular Disease Prevention Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:138-149. [PMID: 30738562 PMCID: PMC6422156 DOI: 10.1016/j.jneb.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). DESIGN Mixed-methods process evaluation. SETTING/PARTICIPANTS A total of 101 women from 8 rural towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were aged ≥40 years, sedentary, and overweight or obese. Local health educators (n = 15) served as program leaders within each town. OUTCOME MEASURES Reach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. ANALYSIS Descriptive statistics, chi-square tests of independence, and thematic analysis were employed. RESULTS Intervention sites reported high levels of fidelity (82%) and dose delivered (84%). Overall reach was 2.6% and program classes were rated as effective (3.9/5). Participants were satisfied with their experience and reported benefits such as camaraderie and awareness of healthy eating and exercise strategies. Common recommendations included increasing class time and enhancing group discussion. CONCLUSIONS AND IMPLICATIONS Implementation was good in terms of fidelity, dose delivered, and satisfaction, although low reach. Findings from this research have informed a second round of implementation and evaluation of the SHHC program in rural communities.
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Affiliation(s)
- Urshila Sriram
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Meredith Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Sara Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Lynn Paul
- College of Education, Health and Development, Montana State University, Bozeman, MT
| | - Rebecca Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
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Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J. School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Cochrane Database Syst Rev 2019; 1:CD011651. [PMID: 30687940 PMCID: PMC6353176 DOI: 10.1002/14651858.cd011651.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes. OBJECTIVES This review has two primary objectives.• To identify the intervention features that are aligned with successful intervention implementation.• To assess effectiveness of school-based interventions provided to improve asthma self-management among children.We addressed the first objective by performing qualitative comparative analysis (QCA), a synthesis method described in depth later, of process evaluation studies to identify the combination of intervention components and processes that are aligned with successful intervention implementation.We pursued the second objective by undertaking meta-analyses of outcomes reported by outcome evaluation studies. We explored the link between how well an intervention is implemented and its effectiveness by using separate models, as well as by undertaking additional subgroup analyses. SEARCH METHODS We searched the Cochrane Airways Trials Register for randomised studies. To identify eligible process evaluation studies, we searched MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Database of Systematic Reviews (CDSR), Web of Knowledge, the Database of Promoting Health Effectiveness Reviews (DoPHER), the Database of Abstracts of Reviews of Effects (DARE), the International Biography of Social Science (IBSS), Bibliomap, Health Technology Assessment (HTA), Applied Social Sciences Index and Abstracts (ASSIA), and Sociological Abstracts (SocAbs). We conducted the latest search on 28 August 2017. SELECTION CRITERIA Participants were school-aged children with asthma who received the intervention in school. Interventions were eligible if their purpose was to help children improve management of their asthma by increasing knowledge, enhancing skills, or changing behaviour. Studies relevant to our first objective could be based on an experimental or quasi-experimental design and could use qualitative or quantitative methods of data collection. For the second objective we included randomised controlled trials (RCTs) where children were allocated individually or in clusters (e.g. classrooms or schools) to self-management interventions or no intervention control. DATA COLLECTION AND ANALYSIS We used qualitative comparative analysis (QCA) to identify intervention features that lead to successful implementation of asthma self-management interventions. We measured implementation success by reviewing reports of attrition, intervention dosage, and treatment adherence, irrespective of effects of the interventions.To measure the effects of interventions, we combined data from eligible studies for our primary outcomes: admission to hospital, emergency department (ED) visits, absence from school, and days of restricted activity due to asthma symptoms. Secondary outcomes included unplanned visits to healthcare providers, daytime and night-time symptoms, use of reliever therapies, and health-related quality of life as measured by the Asthma Quality of Life Questionnaire (AQLQ). MAIN RESULTS We included 55 studies in the review. Thirty-three studies in 14,174 children provided information for the QCA, and 33 RCTs in 12,623 children measured the effects of interventions. Eleven studies contributed to both the QCA and the analysis of effectiveness. Most studies were conducted in North America in socially disadvantaged populations. High school students were better represented among studies contributing to the QCA than in studies contributing to effectiveness evaluations, which more commonly included younger elementary and junior high school students. The interventions all attempted to improve knowledge of asthma, its triggers, and stressed the importance of regular practitioner review, although there was variation in how they were delivered.QCA results highlighted the importance of an intervention being theory driven, along with the importance of factors such as parent involvement, child satisfaction, and running the intervention outside the child's own time as drivers of successful implementation.Compared with no intervention, school-based self-management interventions probably reduce mean hospitalisations by an average of about 0.16 admissions per child over 12 months (SMD -0.19, 95% CI -0.35 to -0.04; 1873 participants; 6 studies, moderate certainty evidence). They may reduce the number of children who visit EDs from 7.5% to 5.4% over 12 months (OR 0.70, 95% CI 0.53 to 0.92; 3883 participants; 13 studies, low certainty evidence), and probably reduce unplanned visits to hospitals or primary care from 26% to 21% at 6 to 9 months (OR 0.74, 95% CI 0.60 to 0.90; 3490 participants; 5 studies, moderate certainty evidence). Self-management interventions probably reduce the number of days of restricted activity by just under half a day over a two-week period (MD 0.38 days 95% CI -0.41 to -0.18; 1852 participants; 3 studies, moderate certainty evidence). Effects of interventions on school absence are uncertain due to the variation between the results of the studies (MD 0.4 fewer school days missed per year with self-management (-1.25 to 0.45; 4609 participants; 10 studies, low certainty evidence). Evidence is insufficient to show whether the requirement for reliever medications is affected by these interventions (OR 0.52, 95% CI 0.15 to 1.81; 437 participants; 2 studies; very low-certainty evidence). Self-management interventions probably improve children's asthma-related quality of life by a small amount (MD 0.36 units higher on the Paediatric AQLQ(95% CI 0.06 to 0.64; 2587 participants; 7 studies, moderate certainty evidence). AUTHORS' CONCLUSIONS School-based asthma self-management interventions probably reduce hospital admission and may slightly reduce ED attendance, although their impact on school attendance could not be measured reliably. They may also reduce the number of days where children experience asthma symptoms, and probably lead to small improvements in asthma-related quality of life. Many of the studies tested the intervention in younger children from socially disadvantaged populations. Interventions that had a theoretical framework, engaged parents and were run outside of children's free time were associated with successful implementation.
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Affiliation(s)
- Katherine Harris
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - Dylan Kneale
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
| | - Toby J Lasserson
- Cochrane Central ExecutiveEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Vanessa M McDonald
- The University of NewcastleSchool of Nursing and Midwifery, Priority Reseach Centre for Asthma and Respiratory DiseaseLocked Bag 1000New LambtionNewcastleNSWAustralia2305
| | - Jonathan Grigg
- Queen Mary University of LondonCentre for Child Health, Blizard InstituteLondonUKE1 2AT
| | - James Thomas
- University College LondonEPPI‐Centre, Social Science Research Unit, UCL Institute of Education20 Bedford WayLondonUKWC1H 0AL
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Boelsen‐Robinson T, Blake MR, Backholer K, Hettiarachchi J, Palermo C, Peeters A. Implementing healthy food policies in health services: A qualitative study. Nutr Diet 2018; 76:336-343. [DOI: 10.1111/1747-0080.12471] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/19/2018] [Accepted: 07/30/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tara Boelsen‐Robinson
- Department of Medicine, Nursing and Health Sciences, School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
| | - Miranda R. Blake
- Department of Medicine, Nursing and Health Sciences, School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
| | - Kathryn Backholer
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
| | - Janitha Hettiarachchi
- Department of Clinical Diabetes and Epidemiology, Baker Institute Melbourne Victoria Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, School of Clinical ScienceMonash University Melbourne Victoria Australia
| | - Anna Peeters
- Global Obesity Centre, School of Health and Social DevelopmentDeakin University Geelong Victoria Australia
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23
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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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24
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Jacobs C, Michelo C, Moshabela M. Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups. Implement Sci 2018; 13:74. [PMID: 29855324 PMCID: PMC5984469 DOI: 10.1186/s13012-018-0766-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically significant improvement in the MNH indicators, targets for key indicators were not achieved, and reasons for this shortfall were not known. This study was aimed at understanding why the targeted key indicators for MNH services were not achieved. METHODS A process evaluation, in accordance with the Medical Research Council (MRC) framework, was conducted in two selected rural districts of Zambia using qualitative approaches. Focus group discussions were conducted with SMAGs, volunteer community health workers, and mothers and in-depth interviews with healthcare providers. Content analysis was done. RESULTS We found that SMAGs implemented much of the intervention as was intended, particularly in the area of women's education and referral to health facilities for skilled MNH services. The SMAGs went beyond their prescribed roles to assist women with household chores and personal problems and used their own resources to enhance the success of the intervention. Deficiencies in the intervention were reported and included poor ongoing support, inadequate supplies and lack of effective transportation such as bicycles needed for the SMAGs to facilitate their work. Factors external to the intervention, such as inadequacy of health services and skilled healthcare providers in facilities where SMAGs referred mothers and poor geographical access, may have led SMAGs to engage in the unintended role of conducting deliveries, thus compromising the outcome of the intervention. CONCLUSION We found evidence suggesting that although SMAGs continue to play pivotal roles in contribution towards accelerated coverage of MNH services among hard-to-reach populations, they are unable to meet some of the critical sets of MNH service-targeted indicators. The complexities of the implementation mechanisms coupled with the presence of setting specific socio-cultural and geographical contextual factors could partially explain this failure. This suggests a need for innovating existing implementation strategies so as to help SMAGs and any other community health system champions to effectively respond to MNH needs of most-at-risk women and promote universal health coverage targeting hard-to-reach groups.
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Affiliation(s)
- Choolwe Jacobs
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia. .,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Charles Michelo
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia.,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, KwaZulu Natal, South Africa
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25
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Webster J, Pillay A, Suku A, Gohil P, Santos JA, Schultz J, Wate J, Trieu K, Hope S, Snowdon W, Moodie M, Jan S, Bell C. Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji. Nutrients 2018; 10:nu10020155. [PMID: 29385758 PMCID: PMC5852731 DOI: 10.3390/nu10020155] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 01/08/2023] Open
Abstract
This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.
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MESH Headings
- Costs and Cost Analysis
- Cyclonic Storms
- Diet, Healthy/economics
- Diet, Healthy/ethnology
- Diet, Sodium-Restricted/economics
- Diet, Sodium-Restricted/ethnology
- Fast Foods/adverse effects
- Fast Foods/analysis
- Fast Foods/economics
- Fiji
- Focus Groups
- Food Industry/economics
- Food, Preserved/adverse effects
- Food, Preserved/analysis
- Food, Preserved/economics
- Health Knowledge, Attitudes, Practice/ethnology
- Health Plan Implementation/economics
- Health Promotion/economics
- Humans
- Hypertension/economics
- Hypertension/ethnology
- Hypertension/etiology
- Hypertension/prevention & control
- Information Dissemination
- Nutrition Surveys/economics
- Patient Compliance/ethnology
- Program Evaluation
- Public-Private Sector Partnerships/economics
- Sodium Chloride, Dietary/adverse effects
- Sodium Chloride, Dietary/analysis
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Affiliation(s)
- Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Arti Pillay
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Arleen Suku
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Paayal Gohil
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Joseph Alvin Santos
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | | | - Jillian Wate
- Pacific Research Centre for the Prevention of Obesity and Noncommunicable Diseases (C-POND), Fiji National University, Nasinu, Fiji.
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
- School of Public Health, the University of Sydney, Sydney, NSW 2006, Australia.
| | - Silvia Hope
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
| | - Wendy Snowdon
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Burwood, VIC 3125, Australia.
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Colin Bell
- Global Obesity Centre, Deakin University, Geelong, VIC 3216, Australia.
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26
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Wojcicki JM, de Schweinitz P. Store owners as potential agents of change: energy drinks in the interior of Alaska. Int J Circumpolar Health 2017; 76:1400362. [PMID: 29157188 PMCID: PMC5700499 DOI: 10.1080/22423982.2017.1400362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 10/30/2017] [Indexed: 11/04/2022] Open
Abstract
Childhood obesity disproportionately impacts disadvantaged communities, including Alaska Native children. In part, lack of access to fresh fruits and vegetables and over consumption of sugar sweetened beverages including energy drinks contribute to excessive weight gain in Alaska Native youth. This commentary reports the possibility of storeowners and workers partnering with community members to limit sales of nutrient-poor energy drinks through point-of-sale counselling in rural communities in the interior of Alaska. This model of intervention may be useful to implement in areas where there are limited health workers or others that can serve as health educators. This study reports preliminary evidence from rural Alaska and from other Arctic communities that store workers may effectively improve community health status by limiting or promoting specific products. Storeowners or workers may be helpful partners in the fight against childhood obesity as they are present at the point of sale of high-risk beverages to Alaska Native youth.
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Affiliation(s)
- Janet M. Wojcicki
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Peter de Schweinitz
- Chief Andrew Isaac Health Center, Medical Services, Tanana Chiefs Conference, Fairbanks, AK, USA
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27
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Adam A, Jensen JD. What is the effectiveness of obesity related interventions at retail grocery stores and supermarkets? -a systematic review. BMC Public Health 2016; 16:1247. [PMID: 28031046 PMCID: PMC5192566 DOI: 10.1186/s12889-016-3985-x] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background The Prevalence of obesity and overweight has been increasing in many countries. Many factors have been identified as contributing to obesity including the food environment, especially the access, availability and affordability of healthy foods in grocery stores and supermarkets. Several interventions have been carried out in retail grocery/supermarket settings as part of an effort to understand and influence consumption of healthful foods. The review’s key outcome variable is sale/purchase of healthy foods as a result of the interventions. This systematic review sheds light on the effectiveness of food store interventions intended to promote the consumption of healthy foods and the methodological quality of studies reporting them. Methods Systematic literature search spanning from 2003 to 2015 (inclusive both years), and confined to papers in the English language was conducted. Studies fulfilling search criteria were identified and critically appraised. Studies included in this review report health interventions at physical food stores including supermarkets and corner stores, and with outcome variable of adopting healthier food purchasing/consumption behavior. The methodological quality of all included articles has been determined using a validated 16-item quality assessment tool (QATSDD). Results The literature search identified 1580 publications, of which 42 met the inclusion criteria. Most interventions used a combination of information (e.g. awareness raising through food labeling, promotions, campaigns, etc.) and increasing availability of healthy foods such as fruits and vegetables. Few used price interventions. The average quality score for all papers is 65.0%, or an overall medium methodological quality. Apart from few studies, most studies reported that store interventions were effective in promoting purchase of healthy foods. Conclusion Given the diverse study settings and despite the challenges of methodological quality for some papers, we find efficacy of in-store healthy food interventions in terms of increased purchase of healthy foods. Researchers need to take risk of bias and methodological quality into account when designing future studies that should guide policy makers. Interventions which combine price, information and easy access to and availability of healthy foods with interactive and engaging nutrition information, if carefully designed can help customers of food stores to buy and consume more healthy foods. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3985-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abdulfatah Adam
- Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, DK-1958, Frederiksberg, Denmark.
| | - Jørgen D Jensen
- Department of Food and Resource Economics, University of Copenhagen, Rolighedsvej 25, DK-1958, Frederiksberg, Denmark
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Wanduru P, Tetui M, Tuhebwe D, Ediau M, Okuga M, Nalwadda C, Ekirapa-Kiracho E, Waiswa P, Rutebemberwa E. The performance of community health workers in the management of multiple childhood infectious diseases in Lira, northern Uganda - a mixed methods cross-sectional study. Glob Health Action 2016; 9:33194. [PMID: 27882866 PMCID: PMC5122228 DOI: 10.3402/gha.v9.33194] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/25/2016] [Accepted: 10/28/2016] [Indexed: 12/03/2022] Open
Abstract
Background Community health workers (CHWs) have the potential to reduce child mortality by improving access to care, especially in remote areas. Uganda has one of the highest child mortality rates globally. Moreover, rural areas bear the highest proportion of this burden. The optimal performance of CHWs is critical. In this study, we assess the performance of CHWs in managing malaria, pneumonia, and diarrhea in the rural district of Lira, in northern Uganda. Designs A cross-sectional mixed methods study was undertaken to investigate the performance of 393 eligible CHWs in the Lira district of Uganda. Case scenarios were conducted with a medical officer observing CHWs in their management of children suspected of having malaria, pneumonia, or diarrhea. Performance data were collected using a pretested questionnaire with a checklist used by the medical officer to score the CHWs. The primary outcome, CHW performance, is defined as the ability to diagnose and treat malaria, diarrhea, and pneumonia appropriately. Participants were described using a three group performance score (good vs. moderate vs. poor). A binary measure of performance (good vs. poor) was used in multivariable logistic regression to show an association between good performance and a range of independent variables. The qualitative component comprised seven key informant interviews with experts who had informed knowledge with regard to the functionality of CHWs in Lira district. Results Overall, 347 CHWs (88.3%) had poor scores in managing malaria, diarrhea, and pneumonia, 26 (6.6%) had moderate scores, and 20 (5.1%) had good scores. The factors that were positively associated with performance were secondary-level education (adjusted odds ratio [AOR] 2.72; 95% confidence interval [CI] 1.50–4.92) and meeting with supervisors in the previous month (AOR 2.52; 95% CI 1.12–5.70). Those factors negatively associated with CHW performance included: serving 100–200 households (AOR 0.24; 95% CI 0.12–0.50), serving more than 200 households (AOR 0.22; 95% CI 0.10–0.48), and an initial training duration lasting 2–3 days (AOR 0.13; 95% CI 0.04–0.41). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance. Conclusions The performance of CHWs in Lira was inadequate. There is a need to consider pre-qualification testing before CHWs are appointed. Providing ongoing support and supervision, and ensuring that CHWs have at least secondary education can be helpful in improving their performance. Health system managers also need to ensure that the CHWs’ workload is moderated as work overload will reduce performance. Finally, although short training programs are beneficial to some degree, they are not sufficient and should be followed up with regular refresher training.
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Affiliation(s)
- Phillip Wanduru
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda;
| | - Moses Tetui
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda.,Umeå International School of Public Health (UISPH), Umeå University, Umeå, Sweden
| | - Doreen Tuhebwe
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
| | - Michael Ediau
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
| | - Monica Okuga
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
| | - Christine Nalwadda
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
| | | | - Peter Waiswa
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda.,Global Health Division, Karolinska Institutet, Solna, Sweden
| | - Elizeus Rutebemberwa
- Makerere University School of Public Health (MakSPH), Makerere University, Kampala, Uganda
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van der Kleij MR, Crone M, Reis R, Paulussen T. Unravelling the factors decisive to the implementation of EPODE-derived community approaches targeting childhood obesity: a longitudinal, multiple case study. Int J Behav Nutr Phys Act 2016; 13:98. [PMID: 27596066 PMCID: PMC5011896 DOI: 10.1186/s12966-016-0423-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/18/2016] [Indexed: 12/25/2022] Open
Abstract
Background Implementation of intersectoral community approaches often fails due to a translational gap between the approach as intended and the approach as implemented in practice. Knowledge about the implementation determinants of such approaches is needed to facilitate future implementation processes. Methods The implementation of five EPODE-derived intersectoral community approaches was studied longitudinally. Semi-structured interviews were held with 189 community stakeholders from four sectors to elucidate which determinants influenced implementation, and if an to which extent determinants differed across communities, sectors and over time. A framework approach was used to analyze our data. Results Twenty-two key determinants of implementation were identified. Facilitators named were mostly proximal (stakeholder level), and barriers were mostly distal (context level). Key determinants varied greatly across sectors and over time, especially between the educational & health care sector and the private, welfare & sports sector. Only ‘perceived importance of IACO goals’ was identified as an universal implementation facilitator. Conclusions Striking differences in determinants were found across sectors and over time. Also, stakeholders expressed that possibilities to adapt the approach to the local context were needed to improve implementation. We therefore propose to develop sector- and time specific leads for implementation, which should be approved and amended (over time) by stakeholders. This so-called ‘mutual adaptation’ allows for the use of both scientific insights and practice-based knowledge, enabling program management and community stakeholders to collaboratively improve their implementation efforts.
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Affiliation(s)
- Maria Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P, Leiden, 2300 RC, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Mathilde Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P, Leiden, 2300 RC, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P, Leiden, 2300 RC, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.,Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Theo Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,TNO Innovation for Life, Expertise Centre Child Health, Leiden, The Netherlands
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Process evaluation of a randomised controlled trial of a diabetes prevention intervention in Dutch primary health care: the SLIMMER study. Public Health Nutr 2016; 19:3027-3038. [PMID: 27256153 DOI: 10.1017/s1368980016001282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate (i) how the SLIMMER intervention was delivered and received in Dutch primary health care and (ii) how this could explain intervention effectiveness. DESIGN A randomised controlled trial was conducted and subjects were randomly allocated to the intervention (10-month combined dietary and physical activity intervention) or the control group. A process evaluation including quantitative and qualitative methods was conducted. Data on process indicators (recruitment, reach, dose received, acceptability, implementation integrity and applicability) were collected via semi-structured interviews with health-care professionals (n 45) and intervention participant questionnaires (n 155). SETTING SLIMMER was implemented in Dutch primary health care in twenty-five general practices, eleven dietitians, nine physiotherapist practices and fifteen sports clubs. SUBJECTS Subjects at increased risk of developing type 2 diabetes were included. RESULTS It was possible to recruit the intended high-risk population (response rate 54 %) and the SLIMMER intervention was very well received by both participants and health-care professionals (mean acceptability rating of 82 and 80, respectively). The intervention programme was to a large extent implemented as planned and was applicable in Dutch primary health care. Higher dose received and participant acceptability were related to improved health outcomes and dietary behaviour, but not to physical activity behaviour. CONCLUSIONS The present study showed that it is feasible to implement a diabetes prevention intervention in Dutch primary health care. Higher dose received and participant acceptability were associated with improved health outcomes and dietary behaviour. Using an extensive process evaluation plan to gain insight into how an intervention is delivered and received is a valuable way of identifying intervention components that contribute to implementation integrity and effective prevention of type 2 diabetes in primary health care.
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31
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Rice K, Te Hiwi B, Zwarenstein M, Lavallee B, Barre DE, Harris SB. Best Practices for the Prevention and Management of Diabetes and Obesity-Related Chronic Disease among Indigenous Peoples in Canada: A Review. Can J Diabetes 2016; 40:216-25. [PMID: 27066857 DOI: 10.1016/j.jcjd.2015.10.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/15/2015] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To carry out a systematic review of interventions that have aimed at improving screening, treatment, prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices. METHODS A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar. RESULTS We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success. CONCLUSIONS Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.
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Affiliation(s)
- Kathleen Rice
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Braden Te Hiwi
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Barry Lavallee
- Department of Medical Education, College of Medicine, Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Douglas Edward Barre
- Department of Health Sciences and Emergency Management, School of Professional Studies, Cape Breton University, Sydney, Nova Scotia, Canada
| | - Stewart B Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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van der Kleij RMJJ, Crone MR, Paulussen TGWM, van de Gaar VM, Reis R. A stitch in time saves nine? A repeated cross-sectional case study on the implementation of the intersectoral community approach Youth At a Healthy Weight. BMC Public Health 2015; 15:1032. [PMID: 26449368 PMCID: PMC4597380 DOI: 10.1186/s12889-015-2306-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background The implementation of programs complex in design, such as the intersectoral community approach Youth At a Healthy Weight (JOGG), often deviates from their application as intended. There is limited knowledge of their implementation processes, making it difficult to formulate sound implementation strategies. Methods For two years, we performed a repeated cross-sectional case study on the implementation of a JOGG fruit and water campaign targeting children age 0–12. Semi-structured observations, interviews, field notes and professionals’ logs entries were used to evaluate implementation process. Data was analyzed via a framework approach; within-case and cross-case displays were formulated and key determinants identified. Principles from Qualitative Comparative Analysis (QCA) were used to identify causal configurations of determinants per sector and implementation phase. Results Implementation completeness differed, but was highest in the educational and health care sector, and higher for key than additional activities. Determinants and causal configurations of determinants were mostly sector- and implementation phase specific. High campaign ownership and possibilities for campaign adaptation were most frequently mentioned as facilitators. A lack of reinforcement strategies, low priority for campaign use and incompatibility of own goals with campaign goals were most often indicated as barriers. Discussion We advise multiple ‘stitches in time’; tailoring implementation strategies to specific implementation phases and sectors using both the results from this study and a mutual adaptation strategy in which professionals are involved in the development of implementation strategies. Conclusion The results of this study show that the implementation process of IACOs is complex and sustainable implementation is difficult to achieve. Moreover, this study reveals that the implementation process is influenced by predominantly sector and implementation phase specific (causal configurations of) determinants.
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Affiliation(s)
- Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.
| | - Theo G W M Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands. .,TNO Research Group Lifestyle, Leiden, The Netherlands.
| | - Vivan M van de Gaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Postbus 9600 zone V-0-P 2300 RC, Leiden, The Netherlands. .,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands. .,Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands. .,The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
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33
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Pawar PS, Nagler EM, Gupta PC, Stoddard AM, Lando HA, Shulman L, Pednekar MS, Kasisomayajula V, Aghi MB, Sinha DN, Sorensen GS. Tracking intervention delivery in the ‘Tobacco-Free Teachers/Tobacco-Free Society’ program, Bihar, India. HEALTH EDUCATION RESEARCH 2015; 30:731-41. [PMID: 26342136 PMCID: PMC4626741 DOI: 10.1093/her/cyv039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 08/06/2015] [Indexed: 05/09/2023]
Abstract
In health education and behavior change interventions, process tracking monitors the delivery of an intervention and its receipt to the intended audience. A randomized controlled trial in the state of Bihar, India was conducted to help school teachers become tobacco free through appropriately designed intervention program and delivery system. We describe the results from process tracking of this intervention delivery. The intervention program was centred on six topics delivered in each school through 12 sessions over 6 successive months. The program deliverers recorded the process measures as total number of sessions and program-components implemented (fidelity); time spent conducting sessions (dose) and proportion of teachers attending at least one session (reach). The outcome measures (teachers’ exposure to intervention messages and tobacco policy adoption) were assessed post-intervention. All 12 sessions were delivered in 33 out of 36 schools. Thirty-one schools implemented all six program components. In 18 schools, ≥95% of the teachers participated in one or more sessions. Thirty-three schools received 12 or more hours of dose. In 29 schools, 100% teachers reported exposure to all program messages. Tobacco policy was adopted by all schools. Thus, the intervention was generally delivered as planned and it had a positive impact on teachers and schools.
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Affiliation(s)
- P. S. Pawar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
- *Correspondence to: P. S. Pawar. E-mail: or
| | - E. M. Nagler
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - P. C. Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
| | - A. M. Stoddard
- Biostatistical Consultant, Pelham, Massachusetts 01002, USA
| | - H. A. Lando
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis 55455, USA and
| | - L. Shulman
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - M. S. Pednekar
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
| | - V. Kasisomayajula
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - M. B. Aghi
- Healis Sekhsaria Institute for Public Health, Navi Mumbai 400701, India
| | - D. N. Sinha
- School of Preventive Oncology, Patna 800001, India
| | - G. S. Sorensen
- Center for Community-Based Research, Dana Farber Cancer Institute; and Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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Lee RM, Rothstein JD, Gergen J, Zachary DA, Smith JC, Palmer AM, Gittelsohn J, Surkan PJ. Process Evaluation of a Comprehensive Supermarket Intervention in a Low-Income Baltimore Community. Health Promot Pract 2015; 16:849-58. [PMID: 26296352 DOI: 10.1177/1524839915599359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supermarket-based interventions are one approach to improving the local food environment and reducing obesity and chronic disease in low-income populations. We implemented a multicomponent intervention that aimed to reduce environmental barriers to healthy food purchasing in a supermarket in Southwest Baltimore. The intervention, Eat Right-Live Well! used: shelf labels and in-store displays promoting healthy foods, sales and promotions on healthy foods, in-store taste tests, increasing healthy food products, community outreach events to promote the intervention, and employee training. We evaluated program implementation through store environment, taste test session, and community event evaluation forms as well as an Employee Impact Questionnaire. The stocking, labeling, and advertising of promoted foods were implemented with high and moderate fidelity. Taste test sessions were implemented with moderate reach and low dose. Community outreach events were implemented with high reach and dose. Supermarket employee training had no significant impact on employees' knowledge, self-efficacy, or behavioral intention for helping customers with healthy purchasing or related topics of nutrition and food safety. In summary, components of this intervention to promote healthy eating were implemented with varying success within a large supermarket. Greater participation from management and employees could improve implementation.
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Affiliation(s)
- Ryan M Lee
- Johns Hopkins University, Baltimore, MD, USA Johns Hopkins Center for a Livable Future, Baltimore, MD, USA
| | | | | | | | - Joyce C Smith
- Johns Hopkins Center for a Livable Future, Baltimore, MD, USA Operation Reachout Southwest, Baltimore, MD, USA
| | - Anne M Palmer
- Johns Hopkins University, Baltimore, MD, USA Johns Hopkins Center for a Livable Future, Baltimore, MD, USA
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35
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van der Kleij R, Coster N, Verbiest M, van Assema P, Paulussen T, Reis R, Crone M. Implementation of intersectoral community approaches targeting childhood obesity: a systematic review. Obes Rev 2015; 16:454-72. [PMID: 25824957 DOI: 10.1111/obr.12273] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/19/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
The implementation of intersectoral community approaches targeting childhood obesity (IACO) is considered challenging. To help overcome these challenges, an overview of the evidence to date is needed. We searched four databases to identify papers that reported on the determinants of successful implementation of IACOs, resulting in the inclusion of 25 studies. We appraised study quality with the Crowe Critical Appraisal Tool and the Quality Framework; reported implementation outcome indicators were reviewed via narrative synthesis. Quality of included studies varied. The most frequently reported indicators of implementation success were fidelity and coverage. Determinants related to the social-political context and the organization were most often cited as influencing implementation, in particular, 'collaboration between community partners', 'the availability of (human) resources' and 'time available for implementation'. The association between determinants and implementation variability was never explicated. We conclude that although some insights into the effective implementation of IACOs are present, more research is needed. Emphasis should be placed on elucidating the relationship between determinants and implementation success. Research should further focus on developing a 'golden standard' for evaluating and reporting on implementation research. These actions will improve the comparison of study outcomes and may constitute the cumulative development of knowledge about the conditions for designing evidence-based implementation strategies.
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Affiliation(s)
- R van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
| | - N Coster
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - M Verbiest
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - P van Assema
- Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T Paulussen
- Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,TNO Leiden, Leiden, The Netherlands
| | - R Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands.,Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
| | - M Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Academic Workplace (AWP) Public Health Zuid-Holland Noord, Leiden, The Netherlands
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36
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Godin K, Leatherdale ST, Elton-Marshall T. A systematic review of the effectiveness of school-based obesity prevention programmes for First Nations, Inuit and Métis youth in Canada. Clin Obes 2015; 5:103-15. [PMID: 25880029 DOI: 10.1111/cob.12099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/10/2015] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Abstract
First Nations, Inuit and Métis (FNIM) youth are disproportionately affected by obesity and represent known a high-risk group in Canada. School-based prevention programmes may have the potential to effectively influence obesity-related health behaviours (i.e. healthy eating and physical activity) among this population. We conducted a systematic review of nine electronic databases (2003-2014) to identify studies that describe school-based programmes that have been developed to improve obesity-related health behaviours and outcomes among FNIM youth in Canada. The objectives of this review were to identify and evaluate the effectiveness of these programmes and assess the strength of the methodologies used to evaluate them. Fifteen studies, representing seven distinct interventions, met our inclusion criteria. The majority of these programmes did not result in significant improvements in outcomes related to obesity, healthy eating, or physical activity among FNIM youth. The studies varied in design rigour and use of evaluation activities. The lack of literature on effective school-based programmes for FNIM youth in Canada that target obesity-related outcomes highlights a priority area for future intervention development, evaluation and dissemination within the peer-reviewed literature. Further research is needed on interventions involving Métis and Inuit youth, secondary school-aged FNIM youth and FNIM youth living in urban settings.
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Affiliation(s)
- K Godin
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - S T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - T Elton-Marshall
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Canada
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37
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Calancie L, Leeman J, Jilcott Pitts SB, Khan LK, Fleischhacker S, Evenson KR, Schreiner M, Byker C, Owens C, McGuirt J, Barnidge E, Dean W, Johnson D, Kolodinsky J, Piltch E, Pinard C, Quinn E, Whetstone L, Ammerman A. Nutrition-related policy and environmental strategies to prevent obesity in rural communities: a systematic review of the literature, 2002-2013. Prev Chronic Dis 2015; 12:E57. [PMID: 25927605 PMCID: PMC4416478 DOI: 10.5888/pcd12.140540] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Residents of rural communities in the United States are at higher risk for obesity than their urban and suburban counterparts. Policy and environmental-change strategies supporting healthier dietary intake can prevent obesity and promote health equity. Evidence in support of these strategies is based largely on urban and suburban studies; little is known about use of these strategies in rural communities. The purpose of this review was to synthesize available evidence on the adaptation, implementation, and effectiveness of policy and environmental obesity-prevention strategies in rural settings. METHODS The review was guided by a list of Centers for Disease Control and Prevention Recommended Community Strategies and Measurements to Prevent Obesity in the United States, commonly known as the "COCOMO" strategies. We searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Public Affairs Information Service, and Cochrane databases for articles published from 2002 through 2013 that reported findings from research on nutrition-related policy and environmental strategies in rural communities in the United States and Canada. Two researchers independently abstracted data from each article, and resolved discrepancies by consensus. RESULTS Of the 663 articles retrieved, 33 met inclusion criteria. The interventions most commonly focused on increasing access to more nutritious foods and beverages or decreasing access to less nutritious options. Rural adaptations included accommodating distance to food sources, tailoring to local food cultures, and building community partnerships. CONCLUSIONS Findings from this literature review provide guidance on adapting and implementing policy and environmental strategies in rural communities.
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Affiliation(s)
- Larissa Calancie
- Department of Nutrition, University of North Carolina, Chapel Hill, Gillings School of Global Public Health, CB No 7426, 1700 MLK/Airport Rd, Room 239, Chapel Hill, NC 27599-7426. Telephone: 315-350-1689.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Laura Kettel Khan
- Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity, Atlanta, Georgia
| | - Sheila Fleischhacker
- National Institutes of Health, Division on Nutrition Research Coordination, Bethesda, Maryland
| | - Kelly R Evenson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michelle Schreiner
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carmen Byker
- Montana State University, Billings, Montana; Ellen Barnidge, Saint Louis University, St. Louis, Missouri
| | - Clint Owens
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jared McGuirt
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Wesley Dean
- US Department of Agriculture Food and Nutrition Service, Washington, DC
| | | | | | | | | | | | | | - Alice Ammerman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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38
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Richards Z, Kostadinov I, Jones M, Richard L, Cargo M. Assessing implementation fidelity and adaptation in a community-based childhood obesity prevention intervention. HEALTH EDUCATION RESEARCH 2014; 29:918-932. [PMID: 25214513 DOI: 10.1093/her/cyu053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Little research has assessed the fidelity, adaptation or integrity of activities implemented within community-based obesity prevention initiatives. To address this gap, a mixed-method process evaluation was undertaken in the context of the South Australian Obesity Prevention and Lifestyle (OPAL) initiative. An ecological coding procedure assessed fidelity and adaptation of activity settings, targets and strategies implemented in the second year of four communities. Implementation integrity reflected fidelity and adaptation to local context, whereas efforts resulting in significant deviations from the original plan were deemed to lack fidelity and integrity. Staff implemented 284 strategies in 205 projects. Results show that 68.3 and 2.1% of strategies were implemented with fidelity or adapted, respectively. Overall, 70.4% of all strategies were implemented with integrity. Staff experienced barriers with 29.6% of strategies. Chi-square analyses show statistically significant associations between implementation integrity and strategy type, intervention and behavioural targets. These relationships are weak to modest. The strongest relationship was found between implementation integrity and proximal target. Staff experienced implementation barriers at the coalition, policy, organization, interpersonal and community levels. The greatest range of barriers was encountered working with organizations. To overcome these barriers, staff took greater ownership, invested more time, persisted and allocated more financial resources.
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Affiliation(s)
- Zoe Richards
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide 5001, Australia, Public Health and Clinical Systems, South Australian Department for Health and Ageing, Adelaide 5001, Australia and Faculté des sciences infirmières, Institut de recherche en santé publique (IRSPUM), Université de Montréal, Montréal H3T 1J4, Canada
| | - Iordan Kostadinov
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide 5001, Australia, Public Health and Clinical Systems, South Australian Department for Health and Ageing, Adelaide 5001, Australia and Faculté des sciences infirmières, Institut de recherche en santé publique (IRSPUM), Université de Montréal, Montréal H3T 1J4, Canada
| | - Michelle Jones
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide 5001, Australia, Public Health and Clinical Systems, South Australian Department for Health and Ageing, Adelaide 5001, Australia and Faculté des sciences infirmières, Institut de recherche en santé publique (IRSPUM), Université de Montréal, Montréal H3T 1J4, Canada
| | - Lucie Richard
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide 5001, Australia, Public Health and Clinical Systems, South Australian Department for Health and Ageing, Adelaide 5001, Australia and Faculté des sciences infirmières, Institut de recherche en santé publique (IRSPUM), Université de Montréal, Montréal H3T 1J4, Canada
| | - Margaret Cargo
- Spatial Epidemiology and Evaluation Research Group, School of Population Health, University of South Australia, Adelaide 5001, Australia, Public Health and Clinical Systems, South Australian Department for Health and Ageing, Adelaide 5001, Australia and Faculté des sciences infirmières, Institut de recherche en santé publique (IRSPUM), Université de Montréal, Montréal H3T 1J4, Canada
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Waqa G, Moodie M, Schultz J, Swinburn B. Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji. Glob Health Promot 2014; 20:23-34. [PMID: 24469301 DOI: 10.1177/1757975913501909] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Nearly one-half of the adult population in Fiji between the ages of 15-64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Community (HYHC) project in Fiji used a settings approach in secondary schools and faith-based organizations to increase the capacity of the whole community, including churches, mosques and temples, to promote healthy eating and regular physical activity, and to prevent unhealthy weight gain in adolescents aged 13-18 years. The team consisted of a study manager, project coordinator and four research assistants (RAs) committed to planning, designing and facilitating the implementation of intervention programs in collaboration with other stakeholders, such as the wider school communities, government and non-governmental organizations and business partners. Process data were collected on all intervention activities and analyzed by dose, frequency and reach for each specific strategy. The Fiji Action Plan included nine objectives for the school settings; four were based on nutrition and two on physical activity in schools, plus three general objectives, namely capacity building, social marketing and evaluation. Long-term change in nutritional behavior was difficult to achieve; a key contributor to this was the unhealthy food served in the school canteens. Whilst capacity-building proved to be one of the best mechanisms for intervening, it is important to consider the cultural and social factors influencing health behaviors and affecting specific groups.
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Affiliation(s)
- Gade Waqa
- 1.College of Medicine, Nursing and Health Sciences, Fiji National University, Fiji
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40
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Gravlee CC, Boston PQ, Mitchell MM, Schultz AF, Betterley C. Food store owners' and managers' perspectives on the food environment: an exploratory mixed-methods study. BMC Public Health 2014; 14:1031. [PMID: 25281272 PMCID: PMC4287570 DOI: 10.1186/1471-2458-14-1031] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neighborhood characteristics such as poverty and racial composition are associated with inequalities in access to food stores and in the risk of obesity, but the pathways between food environments and health are not well understood. This article extends research on consumer food environments by examining the perspectives of food-store owners and managers. METHODS We conducted semistructured, open-ended interviews with managers and owners of 20 food stores in low-income, predominantly African American neighborhoods in Tallahassee, Florida (USA). The interviews were designed to elicit store managers' and owners' views about healthy foods, the local food environment, and the challenges and opportunities they face in creating access to healthy foods. We elicited perceptions of what constitutes "healthy foods" using two free-list questions. The study was designed and implemented in accord with principles of community-based participatory research. RESULTS Store owners' and managers' conceptions of "healthy foods" overlapped with public health messages, but (a) agreement about which foods are healthy was not widespread and (b) some retailers perceived processed foods such as snack bars and sugar-sweetened juice drinks as healthy. In semistructured interviews, store owners and managers linked the consumer food environment to factors across multiple levels of analysis, including: business practices such as the priority of making sales and the delocalization of decision-making, macroeconomic factors such as poverty and the cost of healthier foods, individual and family-level factors related to parenting and time constraints, and community-level factors such as crime and decline of social cohesion. CONCLUSIONS Our results link food stores to multilevel, ecological models of the food environment. Efforts to reshape the consumer food environment require attention to factors across multiple levels of analysis, including local conceptions of "healthy foods", the business priority of making sales, and policies and practices that favor the delocalization of decision making and constrain access to healthful foods.
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Affiliation(s)
- Clarence C Gravlee
- />Department of Anthropology, University of Florida, 1112 Turlington Hall, PO Box 117305, Gainesville, FL 32611-7305 USA
| | - P Qasimah Boston
- />Department of Children & Families, Substance Abuse and Mental Health Program Office, 1317 Winewood Blvd, Bldg 6, Rm 256, Tallahassee, FL 32399 USA
- />Project FOOD Now, Inc, 635 E. College Avenue, Tallahassee, FL 32301 USA
- />Tallahassee Food Network, Inc, P.O. Box 365, Tallahassee, FL 32302 USA
| | - M Miaisha Mitchell
- />Tallahassee Food Network, Inc, P.O. Box 365, Tallahassee, FL 32302 USA
- />Greater Frenchtown Revitalization Council, 812 Goodbread Lane, Tallahassee, FL 32303 USA
| | - Alan F Schultz
- />Department of Anthropology, Baylor University, One Bear Place #97173, Waco, TX 76798-7173 USA
| | - Connie Betterley
- />Leon County Health Department, 2965 Municipal Way, Tallahassee, Florida 32304 USA
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Gittelsohn J, Kim EM, He S, Pardilla M. A food store-based environmental intervention is associated with reduced BMI and improved psychosocial factors and food-related behaviors on the Navajo nation. J Nutr 2013; 143:1494-500. [PMID: 23864511 PMCID: PMC4083230 DOI: 10.3945/jn.112.165266] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The prevalence of obesity is significantly higher among American Indians (AIs) and is associated with increased rates of diabetes, hypertension, and cardiovascular disease. We implemented a 14-mo intervention trial (Navajo Healthy Stores) on the Navajo Nation that sought to increase availability of healthier foods in local food stores and to promote these foods at the point of purchase and through community media. We divided the Navajo Nation into 10 store regions, half of which were randomized to intervention and half to comparison. We evaluated the program by using a pre-post sample of systematically sampled adult Navajo consumers (baseline, n = 276; postintervention, n = 145). Intervention impact was examined by analyzing pre-post differences by intervention group and by intervention exposure level. When intervention and comparison groups were compared, only body mass index (BMI) showed a trend toward impact of the intervention (P = 0.06). However, greater exposure to the intervention was associated with significantly reduced BMI (P ≤ 0.05) and improved healthy food intentions (P ≤ 0.01), healthy cooking methods (P ≤ 0.05), and healthy food getting (P ≤ 0.01). With increasing exposure, the odds of improving overweight or obese status was 5.02 (95% CI: 1.48, 16.99; P ≤ 0.01) times the odds of maintaining or worsening overweight or obese status. In summary, a food store intervention was associated with reduced overweight/obesity and improved obesity-related psychosocial and behavioral factors among those persons most exposed to the intervention on an AI reservation.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA.
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Lee-Kwan SH, Goedkoop S, Yong R, Batorsky B, Hoffman V, Jeffries J, Hamouda M, Gittelsohn J. Development and implementation of the Baltimore healthy carry-outs feasibility trial: process evaluation results. BMC Public Health 2013; 13:638. [PMID: 23837722 PMCID: PMC3716976 DOI: 10.1186/1471-2458-13-638] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 06/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prepared food sources, including fast food restaurants and carry-outs, are common in low-income urban areas. These establishments provide foods high in calories, sugar, fat, and sodium. The aims of the study were to (1) describe the development and implementation of a carry-out intervention to provide and promote healthy food choices in prepared food sources, and (2) to assess its feasibility through a process evaluation. METHODS To promote healthy eating in this setting, a culturally appropriate intervention was developed based on formative research from direct observation, interviews and focus groups. We implemented a 7-month feasibility trial in 8 carry-outs (4 intervention and 4 comparison) in low-income neighborhoods in Baltimore, MD. The trial included three phases: 1) Improving menu boards and labeling to promote healthier items; 2) Promoting healthy sides and beverages and introducing new items; and 3) Introducing affordable healthier combo meals and improving food preparation methods. A process evaluation was conducted to assess intervention reach, dose received, and fidelity using sales receipts, carry-out visit observations, and an intervention exposure assessment. RESULTS On average, Baltimore Healthy Carry-outs (BHC) increased customer reach at intervention carry-outs; purchases increased by 36.8% at the end of the study compared to baseline. Additionally, menu boards and labels were seen by 100.0% and 84.2% of individuals (n = 101), respectively, at study completion compared to baseline. Customers reported purchasing specific foods due to the presence of a photo on the menu board (65.3%) or menu labeling (42.6%), suggesting moderate to high dose received. Promoted entrée availability and revised menu and poster presence all demonstrated high fidelity and feasibility. CONCLUSIONS The results suggest that BHC is a culturally acceptable intervention. The program was also immediately adopted by the Baltimore City Food Policy Initiative as a city-wide intervention in its public markets.
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Affiliation(s)
- Seung Hee Lee-Kwan
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sonja Goedkoop
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel Yong
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin Batorsky
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Hoffman
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jayne Jeffries
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mohamed Hamouda
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Joel Gittelsohn
- Center for Human Nutrition, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Escaron AL, Meinen AM, Nitzke SA, Martinez-Donate AP. Supermarket and grocery store-based interventions to promote healthful food choices and eating practices: a systematic review. Prev Chronic Dis 2013; 10:E50. [PMID: 23578398 PMCID: PMC3625444 DOI: 10.5888/pcd10.120156] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Increasingly high rates of obesity have heightened interest among researchers and practitioners in identifying evidence-based interventions to increase access to healthful foods and beverages. Because most food purchasing decisions are made in food stores, such settings are optimal for interventions aimed at influencing these decisions. The objective of this review was to synthesize the evidence on supermarket and grocery store interventions to promote healthful food choices. Methods We searched PubMed through July 2012 to identify original research articles evaluating supermarket and grocery store interventions that promoted healthful food choices. We categorized each intervention by type of intervention strategy and extracted and summarized data on each intervention. We developed a scoring system for evaluating each intervention and assigned points for study design, effectiveness, reach, and availability of evidence. We averaged points for each intervention category and compared the strength of the evidence for each category. Results We identified 58 articles and characterized 33 interventions. We found 7 strategies used alone or in combination. The most frequently used strategy was the combination of point-of-purchase and promotion and advertising (15 interventions); evidence for this category was scored as sufficient. On average, of 3 points possible, the intervention categories scored 2.6 for study design, 1.1 for effectiveness, 0.3 for reach, and 2 for availability of evidence. Three categories showed sufficient evidence; 4 showed insufficient evidence; none showed strong evidence. Conclusion More rigorous testing of interventions aimed at improving food and beverage choices in food stores, including their effect on diet and health outcomes, is needed.
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Affiliation(s)
- Anne L Escaron
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726-2397, USA.
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Kakekagumick KE, Naqshbandi Hayward M, Harris SB, Saksvig B, Gittelsohn J, Manokeesic G, Goodman S, Hanley AJ. Sandy lake health and diabetes project: a community-based intervention targeting type 2 diabetes and its risk factors in a first nations community. Front Endocrinol (Lausanne) 2013; 4:170. [PMID: 24302919 PMCID: PMC3824247 DOI: 10.3389/fendo.2013.00170] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/24/2013] [Indexed: 11/30/2022] Open
Abstract
The Sandy Lake Health and Diabetes Project (SLHDP) was initiated in 1991 as a partnership between Sandy Lake First Nation and researchers interested in addressing the high rates of type 2 diabetes mellitus (T2DM) in the community. Following the expressed wishes of the community, the SLHDP has encompassed a variety of community-wide interventions and activities including: community surveys to document T2DM prevalence and risk factors, the Northern Store program aimed at increasing the availability and knowledge of healthy food options, a home visit program for the prevention and management of T2DM, a local diabetes radio show, a school diabetes curriculum for grades 3 and 4, a community-wide walking trail to encourage increased physical activity, youth diabetes summer camps, and a variety of community events focusing on nutrition and physical activity. Over the 22 year existence of the SLHDP, the community has taken ownership of the program and activities have evolved in alignment with community needs and priorities. This paper discusses the history, implementation, evaluation, and outcomes of the SLHDP and describes its sustainability. The SLHDP is a model of culturally appropriate participatory research that is iterative, with reciprocal capacity building for both key community stakeholders and academic partners.
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Affiliation(s)
- Kara E. Kakekagumick
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Mariam Naqshbandi Hayward
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Stewart B. Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Brit Saksvig
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Joel Gittelsohn
- Center for Human Nutrition and Johns Hopkins Global Center of Childhood Obesity, Department of International Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gary Manokeesic
- Sandy Lake Health and Diabetes Program, Sandy Lake First Nation, ON, Canada
| | - Starsky Goodman
- Sandy Lake Health and Diabetes Program, Sandy Lake First Nation, ON, Canada
| | - Anthony J. Hanley
- Departments of Nutritional Sciences and Medicine and Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- *Correspondence: Anthony J. Hanley, Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, FitzGerald Building, 150 College Street, Room 341, Toronto, ON M5S 3E2, Canada e-mail:
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Born K, Orkin A, VanderBurgh D, Beardy J. Teaching wilderness first aid in a remote First Nations community: the story of the Sachigo Lake Wilderness Emergency Response Education Initiative. Int J Circumpolar Health 2012; 71:19002. [PMID: 23110258 PMCID: PMC3482695 DOI: 10.3402/ijch.v71i0.19002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/11/2012] [Accepted: 09/15/2012] [Indexed: 11/26/2022] Open
Abstract
Objective To understand how community members of a remote First Nations community respond to an emergency first aid education programme. Study design A qualitative study involving focus groups and participant observation as part of a community-based participatory research project, which involved the development and implementation of a wilderness first aid course in collaboration with the community. Methods Twenty community members participated in the course and agreed to be part of the research focus groups. Three community research partners validated and reviewed the data collected from this process. These data were coded and analysed using open coding. Results Community members responded to the course in ways related to their past experiences with injury and first aid, both as individuals and as members of the community. Feelings of confidence and self-efficacy related access to care and treatment of injury surfaced during the course. Findings also highlighted how the context of the remote First Nations community influenced the delivery and development of course materials. Conclusions Developing and delivering a first aid course in a remote community requires sensitivity towards the response of participants to the course, as well as the context in which it is being delivered. Employing collaborative approaches to teaching first aid can aim to address these unique needs. Though delivery of a first response training programme in a small remote community will probably not impact the morbidity and mortality associated with injury, it has the potential to impact community self-efficacy and confidence when responding to an emergency situation.
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Affiliation(s)
- Karen Born
- Institute of Health Policy & Management, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Nakkash RT, Alaouie H, Haddad P, El Hajj T, Salem H, Mahfoud Z, Afifi RA. Process evaluation of a community-based mental health promotion intervention for refugee children. HEALTH EDUCATION RESEARCH 2012; 27:595-607. [PMID: 21908850 PMCID: PMC3396877 DOI: 10.1093/her/cyr062] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 07/06/2011] [Indexed: 05/31/2023]
Abstract
Public health interventions are complex in nature and composed of multiple components. Evaluation of process and impact is necessary to build evidence of effectiveness. Process evaluation involves monitoring extent of implementation and comparison against the program plan. This article describes the process evaluation of the 'Qaderoon' (We are Capable) intervention; a community-based mental health promotion intervention for children living in a Palestinian refugee camp of Beirut, Lebanon. The manuscript describes the context of Palestinian refugees in Lebanon, the intervention, the process evaluation plan and results. The process evaluation was guided by the literature and by a Community Youth Committee. Findings indicated that attendance was 54 and 38% for summer and fall sessions, respectively. Session objectives and activities were commonly achieved. Over 78.4% of activities were reported to be implemented fully as planned. Over 90% of the children indicated high satisfaction with the sessions. Contextual facilitators and challenges to implementing the intervention are discussed. The most challenging were maintaining attendance and the actual implementation of the process evaluation plan. Findings from process evaluation will strengthen interpretation of impact evaluation results.
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Affiliation(s)
- Rima T. Nakkash
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Hala Alaouie
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Pascale Haddad
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Taghreed El Hajj
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Heba Salem
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Ziyad Mahfoud
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
- Department of Public Health, Weill Cornell Medical College PO Box 24144, Doha, Qatar
| | - Rema A. Afifi
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
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Fialkowski MK, Okoror TA, Boushey CJ. The relevancy of community-based methods: using diet within Native American and Alaska Native adult populations as an example. Clin Transl Sci 2012; 5:295-300. [PMID: 22686210 PMCID: PMC4407991 DOI: 10.1111/j.1752-8062.2011.00364.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The rates of obesity, diabetes, and heart disease in Native Americans and Alaska Natives far exceed that of the general US population. There are many postulating reasons for these excessive rates including the transition from a traditional to a contemporary diet. Although information on the dietary intakes of Native American and Alaska Native communities are limited, there seems to be a consensus that the Native American and Alaska Native diet is high in total fat, saturated fat, cholesterol, and sodium. Further information on the diet needs to be attained so that dietary interventions can effectively be implemented in these communities. An approach that is community based is proposed as the best solution to understanding the Native diet and developing culturally tailored interventions to sustainably improve diet.
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Affiliation(s)
- Marie K. Fialkowski
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Titilayo A. Okoror
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Carol J. Boushey
- Department of Foods and Nutrition, Purdue University, West Lafayette, Indiana, USA
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Barte JCM, ter Bogt NCW, Beltman FW, van der Meer K, Bemelmans WJE. Process Evaluation of a Lifestyle Intervention in Primary Care. HEALTH EDUCATION & BEHAVIOR 2011; 39:564-73. [DOI: 10.1177/1090198111422936] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Groningen Overweight and Lifestyle (GOAL) intervention effectively prevents weight gain. The present study describes a process evaluation in which 214 participants in the intervention group received a structured questionnaire within 7 months (a median of 5 months) after the end of the intervention. The authors investigated the content of the intervention (on basis of the participants’ recall), the participants’ satisfaction of the intervention, the participants’ satisfaction with the nurse practitioners (NPs), and the determinants of the participants’ satisfaction. In general, the results show that the content corresponded well with the protocol for the intervention, except for the number of telephone calls and the percentage of participants with individualized goals for a healthy lifestyle. The overall satisfaction of the participants was high, and success and perceived success and a low educational level were important determinants for a higher overall satisfaction grade. Furthermore, the NP was considered to be an expert and motivational to learning and keeping up a healthy lifestyle. The authors therefore conclude that the GOAL study is feasible and indicates that the NP is well equipped to treat these patients. However, it is recommended to reinforce the advice given and the lifestyle goals after the first contact sessions.
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Affiliation(s)
- Jeroen C. M. Barte
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
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Groeneveld IF, Proper KI, Absalah S, van der Beek AJ, van Mechelen W. An individually based lifestyle intervention for workers at risk for cardiovascular disease: a process evaluation. Am J Health Promot 2011; 25:396-401. [PMID: 21721966 DOI: 10.4278/ajhp.091001-quan-319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Evaluate counselors' adherence to an intervention protocol, counselors' competence, and the associations between three process indicators and body weight at follow-up in a 6-month individually based lifestyle intervention for construction workers. DESIGN Process evaluation with qualitative and quantitative data. SETTING Occupational health service. SUBJECTS A total of 408 male construction workers with an elevated risk of cardiovascular disease received the intervention, and 27 occupational health professionals delivered the intervention. INTERVENTION Seven counseling sessions, the first during which four prescribed items had to be discussed. Motivational interviewing (MI) was used as a counseling technique. MEASURES AND ANALYSIS The number of sessions and the items discussed were registered by the counselors. Adherence to MI was determined by expert scoring of transcripts of random segments of 19 counseling sessions. Counselors' competence was rated by participants and counselors separately. Associations between three process indicators and body weight at follow-up were determined by linear and logistic regression analyses. RESULTS Two-thirds of all participants attended five or more sessions, and 38.5% attended all seven sessions. In 90.2% of all cases, the counselor discussed all obligatory items in the first session. MI adherence was reached in one audiotaped fragment. Most (86.3%) of all participants agreed with the counselor being competent. Neither counselors' competence nor number of sessions or items discussed was significantly associated with body weight loss. CONCLUSIONS Performing five sessions and discussing four prescribed items was feasible for the counselors, whereas performing MI was not. Still, participants were positive about the counselors' competence and willing to attend the intervention sessions. Investigators are encouraged to report the evaluation of their intervention process to improve future lifestyle interventions in research or in practice.
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Affiliation(s)
- Iris F Groeneveld
- VU University Medical Center/EMGO+ Institute, Department of Public and Occupational Health, Van der Boechorststraat 7, Amsterdam, Noord Holland 1081 BT, The Netherlands.
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Kliche T, Plaumann M, Nöcker G, Dubben S, Walter U. Disease prevention and health promotion programs: benefits, implementation, quality assurance and open questions—a summary of the evidence. J Public Health (Oxf) 2011. [DOI: 10.1007/s10389-011-0413-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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