Validation and refinement of the Stakeholder-driven Community Diffusion Survey for childhood obesity prevention

Developing and Evaluating a Data-Driven and Systems Approach to Health Promotion Among Vocational Students: Protocol for the Data Health Study

BACKGROUND

Vocational school students exhibit significant risk behaviors in terms of poor diet, frequent use of nicotine products, inadequate fruit and vegetable intake, low levels of physical activity, and poor mental health. This makes vocational students vulnerable to the development of noncommunicable diseases. Therefore, effective health promotion programs targeting vocational students are required.

OBJECTIVE

The Danish study "Data-driven and Systems Approach to Health Promotion Among Vocational Students" (Data Health) aims to develop, implement, and evaluate a systems approach to support vocational schools, municipalities, and local communities in implementing locally relevant health promotion actions among and for vocational students. This paper describes the Data Health program and how implementation and preliminary effectiveness will be evaluated.

METHODS

The Data Health program offers an iterative 5-step process to develop changes in the systems that shape health behavior and well-being among vocational students. The program will be implemented and evaluated in 8 Danish vocational schools in 4 municipalities. The implementation of the process and actions will be explored using a systems-based evaluation design that assesses contextual differences and the mechanisms through which the program leads to changes in the systems. Preliminary effectiveness at the individual level (students' self-reported health behavior and well-being) and organizational level (school organizational readiness reported by school staff) will be assessed using a quasi-experimental design, and cross-sectional data will be collected at all 8 schools simultaneously 4 times during the 2-year study period.

RESULTS

This study was launched in 2021, and data collection is expected to be completed in June 2024. The first results are expected to be submitted for publication in January 2024.

CONCLUSIONS

We expect that the Data Health study will make significant contributions to complex intervention research by contributing to the paucity of research studies that have used systems approaches in school settings. The study will also provide evidence of successful elements for systems change and effectiveness to determine whether a national scale-up can be recommended.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05308459; https://clinicaltrials.gov/study/NCT05308459.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52571.

Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study

BACKGROUND

Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments.

METHODS

We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis.

RESULTS

Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003).

CONCLUSION

SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.

Using Agent-Based Modeling to Extrapolate Community-Wide Impact from a Stakeholder-Driven Childhood Obesity Prevention Intervention: Shape Up Under 5

Objective: Whole-of-community interventions are a promising systems-based approach to childhood obesity prevention. A theorized driver of success is "Stakeholder-Driven Community Diffusion" (SDCD): the spread of knowledge about and engagement with obesity prevention efforts from a committee of stakeholder representatives. We focus on the potential of SDCD to affect the broader community. Methods: We use an agent-based model of SDCD to dynamically represent the interpersonal interactions that drive community diffusion of knowledge and engagement. We test its explanatory power using longitudinal data from a sample of community members and then use simulations to extrapolate from this limited sample to the unobserved community at large. We also consider counterfactual scenarios that show how changes in implementation strategy might have led to different patterns of community change. Results: Our model can reproduce real-world patterns of diffusion. Simulations show a substantial increase in knowledge (an approximate doubling) and a slight increase in engagement throughout the broader community. A relatively small amount of this change in knowledge (∼10%), and all the change in engagement is attributable to direct intervention effects on committee members. Conclusions: SDCD is premised on creating preconditions for sustainable change. Previous work has estimated impact on small samples closely linked to the stakeholder committee, but the degree to which this translates into the much broader diffusion envisioned by SDCD theory is unknown. This analysis demonstrates the potential of interventions to do just that. Additionally, the counterfactual scenarios suggest that simulation can help tailor implementation of SDCD interventions to increase impact.

A psychometric evaluation of Chinese chronic hepatitis B virus infection-related stigma scale using classical test theory and item response theory

Purpose

To validate the hepatitis B virus infection-related stigma scale (HBVISS) using Classical Test Theory and Item Response Theory in a sample of Chinese chronic HBV carriers.

Methods

Feasibility, internal consistency reliability, split-half reliability and construct validity were evaluated using a cross-sectional validation study (n = 1,058) in Classical Test Theory. Content validity was assessed by COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. The Item Response Theory (IRT) model parameters were estimated using Samejima's graded response model, after which item response category characteristic curves were drawn. Item information, test information, and IRT-based marginal reliability were calculated. Measurement invariance was assessed using differential item functioning (DIF). SPSS and R software were used for the analysis.

Results

The response rate reached 96.4% and the scale was completed in an average time of 5 min. Content validity of HBVISS was sufficient (+) and the quality of the evidence was high according to COSMIN criteria. Confirmatory factor analysis showed acceptable goodness-of-fit (χ ²/df = 5.40, standardized root mean square residual = 0.057, root mean square error of approximation = 0.064, goodness-of-fit index = 0.902, comparative fit index = 0.925, incremental fit index = 0.926, and Tucker-Lewis index = 0.912). Cronbach's α fell in the range of 0.79-0.89 for each dimension and 0.93 for the total scale. Split-half reliability was 0.96. IRT discrimination parameters were estimated to range between 0.959 and 2.333, and the threshold parameters were in the range-3.767 to 3.894. The average score for test information was 12.75 (information >10) when the theta level reached between-4 and + 4. The IRT-based marginal reliability was 0.95 for the total scale and fell in the range of 0.83-0.91 for each dimension. No measurement invariance was detected (d-R ² < 0.02).

Conclusion

HBVISS exhibited good feasibility, reliability, validity, and item quality, making it suitable for assessing chronic Hepatitis B virus infection-related stigma.