Factors influencing the adoption of a healthy eating campaign by federal cross-sector partners: a qualitative study

Systems approaches to scaling up: a systematic review and narrative synthesis of evidence for physical activity and other behavioural non-communicable disease risk factors

BACKGROUND

Non-communicable diseases (NCDs) are the leading causes of death worldwide. Systems approaches have potential for creating sustainable outcomes at scale but have rarely been used to support scale up in physical activity/nutrition promotion or NCD prevention more generally. This review aimed to: (i) synthesise evidence on the use of systems approaches in scaling up interventions targeting four behavioural risk factors for NCDs; and (ii) to explore how systems approaches have been conceptualised and used in intervention implementation and scale up.

METHOD

Seven electronic databases were searched for studies published 2016-2021. Eligible studies targeted at least one of four NCD behavioural risk factors (physical inactivity, tobacco use, alcohol consumption, diet), or described evaluation of an intervention planned for or scaled up. Studies were categorised as having a (i) high, (ii) moderate, or (iii) no use of a systems approach. A narrative synthesis of how systems approaches had been operationalised in scale up, following PRISMA guidelines.

RESULTS

Twenty-one intervention studies were included. Only 19% (n = 4) of interventions explicitly used systems thinking to inform intervention design, implementation and scale up (targeting all four risk factors n = 2, diet n = 1, tobacco use n = 1). Five studies ('high use') planned and implemented scale up with an explicit focus on relations between system elements and used system changes to drive impact at scale. Seven studies ('moderate use') considered systems elements impacting scale-up processes or outcomes but did not require achieving system-level changes from the outset. Nine studies ('no use') were designed to work at multiple levels among multiple agencies in an intervention setting, but the complexity of the system and relations between system elements was not articulated. We synthesised reported barriers and facilitators to scaling up, and how studies within each group conceptualised and used systems approaches, and methods, frameworks and principles for scaling up.

CONCLUSION

In physical activity research, and NCD prevention more broadly, the use of systems approaches in scale up remains in its infancy. For researchers, practitioners and policymakers wishing to adopt systems approaches to intervention implementation at scale, guidance is needed on how to communicate and operationalise systems approaches in research and in practice.

TRIAL REGISTRATION

PROSPERO (CRD42021287265).

Public-Public Collaboration for Food Safety Risk Management: Essence, Modes, and Identification of Key Influencing Factors Using DANP

Objective

Food safety risk management is an important cross-boundary issue from both theoretical and practical standpoints. Because food safety has the social attributes of public goods, public-public collaboration can be considered a particularly important mode of cross-boundary governance. The study aims to provide a theoretical basis for the Chinese government to promote public-public collaboration for food safety risk management by identifying key factors.

Methods

Based on a review of literature across diverse fields, such as political science, sociology, and new public governance, this study discusses the essence, modes, and dilemma of public-public collaboration for food safety risk management using practical explorations in various countries as the main thread and taking into account the actual situation in China. Moreover, this study quantitatively analyzes the relationships between the dimensions and factors affecting public-public collaboration and identifies key dimensions and factors using the Decision-making Trial and Evaluation Laboratory-based Analytic Network Process (DANP).

Results

Among the 20 factors in the calculation results of DANP, Lawmaking has the highest value of (fi+ei) (7.022) and ranks sixth in terms of influence weight. The (fi+ei)value of Professionalism (6.993) ranks second and its influence weight ranks fourth. The (fi+ei) value of Administrative enforcement (6.722) ranks fifth, and its influence weight ranks seventh. The (fi+ei) value of Improvement of the social environment (6.699) ranks sixth, and its influence weight ranks fifth. The (fi+ei) value of Legal authorization (6.614) ranks seventh, and its influence weight ranks tenth. Data analysis indicated that these are the five key factors affecting the governance capacity in public-public collaboration for food safety risk management.

Conclusion

The legal basis is the most important dimension affecting public-public collaboration. Legislation-based governance, administrative law enforcement–based governance, and social environment improvement–based governance in the behavior and capabilities dimension, professionalism in the basic characteristics dimension, and laws and regulations in the legal basis dimension are the five key factors.

Aligning healthcare, public health and social services: A scoping review of the role of purpose, governance, finance and data

Organisations spanning social services, public health and healthcare have increasingly experimented with collaboration as a tool for improving population health and reducing health disparities. While there has been progress, the results have fallen short of expectations. Reflecting on these shortcomings, the Robert Wood Johnson Foundation (RWJF) recently proposed a new framework for cross-sector alignment intended to move the field towards improved outcomes. A central idea in this framework is that collaboratives will be more effective and sustainable if they develop collaborative systems in four core areas: shared purpose, governance, finance and shared data. The goal of this paper is to provide a foundation for research on the four core areas of the cross-sector alignment framework. Accordingly, this study is based on two guiding questions: (1) how are collaboratives currently implementing systems in the four core areas identified in the framework, and (2) what strategies does the literature offer for creating sustainable systems in these four areas? Given the emergent nature of research on health-oriented cross-sector collaboration and the broad research questions, we conducted a systematic scoping review including 179 relevant research papers and reports published internationally from the years 2010-2020. We identified the main contributions and coded each based on its relevance to the cross-sector alignment framework. We found that most papers focused on programme evaluations rather than theory testing, and while many strategies were offered, they tended to reflect a focus on short-term collaboration. The results also demonstrate that starting points and resource levels vary widely across individuals and organisations involved in collaborations. Accordingly, identifying and comparing distinct pathways by which different parties might pursue cross-sector alignment is an imperative for future work. More broadly, the literature is ripe with observations that could be assessed systematically to produce a firm foundation for research and practice.

Hands-on Cooking in Medical Schools: Diffusion of a Prevention Education Innovation

Educating physicians early and often on how to have conversations with patients about diet to prevent and treat chronic disease is imperative, yet under realized. Some innovative medical schools have begun implementing hands-on cooking (HOC) programs to fill this gap, but how these programs are promoted is unknown. This study assessed the prevalence and innovation characteristics of HOC programs offered to medical students in the USA. Content analysis of webpages was conducted using a Diffusion of Innovation (e.g., relative advantage, compatibility, complexity, trialability, and observability) framework. Themes of relative advantage included increasing students' confidence, improvements in medical and interprofessional education, and translating into a benefit to patients through improved care. Compatibility codes showed only a quarter of webpages referred to the program as "evidence-based." Complexity codes showed most (86%) webpages clearly described the course. About half the webpages described the program as an elective, suggesting trialability of this innovation. Many (43%) of the programs referenced use of a standardized "culinary medicine" curriculum, contributing to the observability of this innovation. Within the sample of schools, 35% provided HOC programs for their students. These findings suggest HOC programs have a strong foothold in healthcare education and provide a framework from which future studies might examine what effects innovative, successful HOC programs have on curriculum development, student experience, and, ultimately, patient outcomes.

Systematic review: a systems innovation perspective on barriers and facilitators for the implementation of healthy food-store interventions

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.

Promoting meal planning through mass media: awareness of a nutrition campaign among Canadian parents

OBJECTIVE

To evaluate awareness of the Eat Well Campaign (EWC) among parents and assess perceptions about its effectiveness.

DESIGN

Post-campaign evaluation study with a cross-section of parents recruited through random digit dialling. Participants completed an online survey about EWC awareness, its perceived effectiveness among parents and their meal planning practices (attitudes, behaviours and self-efficacy).

SETTING

A federal mass-media campaign disseminated by Health Canada (2013-2014) to promote meal planning to Canadian parents.

PARTICIPANTS

Parents (n 964) of children aged 2-12 years from all Provinces and Territories.

RESULTS

Of respondents, 41 % (390/964) were aware of the campaign; Quebec City and rural Quebec had the highest rates of awareness, whereas Vancouver, Winnipeg and Toronto had the lowest. Awareness was greater among parents with lower income, basic education and French-speakers. Campaign intensity was significantly associated with greater odds of reporting positive attitudes towards the EWC and meal planning (P < 0·05). Campaign awareness was significantly associated with greater odds of believing that meal planning helps maintain a healthy diet (OR = 1·68, 95 % CI 1·03, 2·74) and planning meals (OR = 1·66, 95 % CI 1·03, 2·54), but not self-efficacy, in adjusted models.

CONCLUSIONS

The present study is the first to evaluate an initiative that promoted meal planning with mass media. The EWC demonstrated evidence of success in terms of equitable access to a nutrition initiative by reaching lower-income and less-educated parents. Understanding behavioural factors among different segments of the population will be important to target appropriate audiences and develop tailored interventions that support healthy eating practices.

Facilitators and barriers experienced by federal cross-sector partners during the implementation of a healthy eating campaign

OBJECTIVE

To identify facilitators and barriers that Health Canada's (HC) cross-sector partners experienced while implementing the Eat Well Campaign: Food Skills (EWC; 2013-2014) and describe how these experiences might differ according to distinct partner types.

DESIGN

A qualitative study using hour-long semi-structured telephone interviews conducted with HC partners that were transcribed verbatim. Facilitators and barriers were identified inductively and analysed according partner types.

SETTING

Implementation of a national mass-media health education campaign.

SUBJECTS

Twenty-one of HC's cross-sector partners (food retailers, media and health organizations) engaged in the EWC.

RESULTS

Facilitators and barriers were grouped into seven major themes: operational elements, intervention factors, resources, collaborator traits, developer traits, partnership factors and target population factors. Four of these themes had dual roles as both facilitators and barriers (intervention factors, resources, collaborator traits and developer traits). Sub-themes identified as both facilitators and barriers illustrate the extent to which a facilitator can easily become a barrier. Partnership factors were unique facilitators, while operational and target population factors were unique barriers. Time was a barrier that was common to almost all partners regardless of partnership type. There appeared to be a greater degree of uniformity among facilitators, whereas barriers were more diverse and unique to the realities of specific types of partner.

CONCLUSIONS

Collaborative planning will help public health organizations anticipate barriers unique to the realities of specific types of organizations. It will also prevent facilitators from becoming barriers. Advanced planning will help organizations manage time constraints and integrate activities, facilitating implementation.