Effectively communicating with local policymakers: a randomized trial of policy brief dissemination to address obesity

Introduction

Evidence-based policies are a powerful tool for impacting health and addressing obesity. Effectively communicating evidence to policymakers is critical to ensure evidence is incorporated into policies. While all public health is local, limited knowledge exists regarding effective approaches for improving local policymakers' uptake of evidence-based policies.

Methods

Local policymakers were randomized to view one of four versions of a policy brief (usual care, narrative, risk-framing, and narrative/risk-framing combination). They then answered a brief survey including questions about their impressions of the brief, their likelihood of using it, and how they determine legislative priorities.

Results

Responses from 331 participants indicated that a majority rated local data (92%), constituent needs/opinions (92%), and cost-effectiveness data (89%) as important or very important in determining what issues they work on. The majority of respondents agreed or strongly agreed that briefs were understandable (87%), believable (77%), and held their attention (74%) with no brief version rated significantly higher than the others. Across the four types of briefs, 42% indicated they were likely to use the brief. Logistic regression models showed that those indicating that local data were important in determining what they work on were over seven times more likely to use the policy brief than those indicating that local data were less important in determining what they work on (aOR = 7.39, 95% CI = 1.86,52.57).

Discussion

Among local policymakers in this study there was no dominant format or type of policy brief; all brief types were rated similarly highly. This highlights the importance of carefully crafting clear, succinct, credible, and understandable policy briefs, using different formats depending on communication objectives. Participants indicated a strong preference for receiving materials incorporating local data. To ensure maximum effect, every effort should be made to include data relevant to a policymaker's local area in policy communications.

Sleep, Stress, and Cardiometabolic Health in Women of Childbearing Age with Overweight and Obesity

Background

Sleep is important for health, but its relationship to cardiometabolic health in women of childbearing age remains unclear. Furthermore, stress, unmet basic needs, and lack of physical activity may be related to disrupted sleep and poor cardiometabolic health in women of childbearing age and these relationships may differ by ethnicity. The purposes of this study were to investigate the relationship between sleep, markers of cardiometabolic health, stress, unmet basic needs, and physical activity in women of childbearing age with overweight or obesity and identify if these relationships differed between women that identified as Latino/Hispanic and non-Latino/Hispanic ethnicity.

Methods

A secondary cross-sectional analysis was conducted using baseline data from a trial that embeds healthy eating and activity into a national home visiting program, Parents as Teachers. The sample was stratified based on self-reported ethnicity (Hispanic/Latino or non-Hispanic/Latino). Pearson's and Spearman's correlations were used to determine bivariate relationships among sleep, cardiometabolic variables, stress, unmet basic needs, and physical activity.

Results

Two hundred seventy-six women, 46% of whom identified as Hispanic/Latino, were included in the analysis. Body mass index (BMI) was significantly correlated with sleep disturbance (ρ = 0.23, p = 0.01) in women who identify as Hispanic/Latino. Stress was positively related to sleep disturbance, sleep duration, and unmet needs for both groups of women. BMI was correlated with unmet basic needs in women who identified as non-Hispanic/Latino (ρ = 0.25, p = 0.01).

Conclusions

Our results suggest that sleep, stress, and basic needs are important in understanding cardiometabolic health in women of childbearing age and these relationships differ depending on ethnicity. Clinical Trial Registration Number: NCT03758638.

Designing for dissemination among public health and clinical practitioners in the USA

Introduction

The slow adoption of evidence-based interventions reflects gaps in effective dissemination of research evidence. Existing studies examining designing for dissemination (D4D), a process that ensures interventions and implementation strategies consider adopters' contexts, have focused primarily on researchers, with limited perspectives of practitioners. To address these gaps, this study examined D4D practice among public health and clinical practitioners in the USA.

Methods

We conducted a cross-sectional study among public health and primary care practitioners in April to June 2022 (analyzed in July 2022 to December 2022). Both groups were recruited through national-level rosters. The survey was informed by previous D4D studies and pretested using cognitive interviewing.

Results

Among 577 respondents, 45% were public health and 55% primary care practitioners, with an overall survey response rate of 5.5%. The most commonly ranked sources of research evidence were email announcements for public health practitioners (43.7%) and reading academic journals for clinical practitioners (37.9%). Practitioners used research findings to promote health equity (67%) and evaluate programs/services (66%). A higher proportion of clinical compared to public health practitioners strongly agreed/agreed that within their work setting they had adequate financial resources (36% vs. 23%, p < 0.001) and adequate staffing (36% vs. 24%, p = 0.001) to implement research findings. Only 20% of all practitioners reported having a designated individual or team responsible for finding and disseminating research evidence.

Conclusions

Addressing both individual and modifiable barriers, including organizational capacity to access and use research evidence, may better align the efforts of researchers with priorities and resources of practitioners.

Integrating a focus on health equity in implementation science: Case examples from the national cancer institute's implementation science in cancer control centers (ISC3) network

Background

A Health Equity Task Force (HETF) of members from seven Centers funded by the National Cancer Institute's (NCI) Implementation Science in Cancer Control Centers (ISC3) network sought to identify case examples of how Centers were applying a focus on health equity in implementation science to inform future research and capacity-building efforts.

Methods

HETF members at each ISC3 collected information on how health equity was conceptualized, operationalized, and addressed in initial research and capacity-building efforts across the seven ISC3 Centers funded in 2019-2020. Each Center completed a questionnaire assessing five health equity domains central to implementation science (e.g., community engagement; implementation science theories, models, and frameworks (TMFs); and engaging underrepresented scholars). Data generated illustrative examples from these five domains.

Results

Centers reported a range of approaches focusing on health equity in implementation research and capacity-building efforts, including (1) engaging diverse community partners/settings in making decisions about research priorities and projects; (2) applying health equity within a single TMF applied across projects or various TMFs used in specific projects; (3) evaluating health equity in operationalizing and measuring health and implementation outcomes; (4) building capacity for health equity-focused implementation science among trainees, early career scholars, and partnering organizations; and (5) leveraging varying levels of institutional resources and efforts to engage, include, and support underrepresented scholars.

Conclusions

Examples of approaches to integrating health equity across the ISC3 network can inform other investigators and centers' efforts to build capacity and infrastructure to support growth and expansion of health equity-focused implementation science.

Protocol for a scoping review of health equity frameworks and models applied in empirical studies of chronic disease prevention and control

BACKGROUND

Chronic diseases, such as cancers and cardiovascular diseases, present the greatest burden of morbidity and mortality worldwide. This burden disproportionately affects historically marginalized populations. Health equity is rapidly gaining increased attention in public health, health services, and implementation research, though many health inequities persist. Health equity frameworks and models (FM) have been called upon to guide equity-focused chronic disease and implementation research. However, there is no clear synthesis of the health equity FM used in chronic disease research or how these are applied in empirical studies. This scoping review seeks to fill this gap by identifying and characterizing health equity FM applied in empirical studies along the chronic disease prevention and control continuum, describing how these FM are used, and exploring potential applications to the field of implementation science.

METHODS

We follow established guidance for conducting scoping reviews, which includes six stages: (1) identify the research question; (2) identify relevant studies; (3) select studies for inclusion; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) consultation. This protocol presents the iterative, collaborative approach taken to conceptualize this study and develop the search strategy. We describe the criteria for inclusion in this review, methods for conducting two phases of screening (title and abstract, full text), data extraction procedures, and quality assurance approaches taken throughout the project.

DISCUSSION

The findings from this review will inform health-equity focused chronic disease prevention and control research. FM identified through this review will be added to an existing website summarizing dissemination and implementation science frameworks, and we will offer case examples and recommendations for utilizing a health equity FM in empirical studies. Our search strategy and review methodology may serve as an example for scholars seeking to conduct reviews of health equity FM in other health disciplines.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework Registration https://doi.org/10.17605/OSF.IO/SFVE6.

Developing Priorities to Alleviate the Long-Term Impact of the COVID-19 Pandemic on Women Engaged in Diabetes Research, Education, and Care: A Concept Mapping Study

Objective

The aim of this study was to develop priorities through stakeholder engagement to alleviate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the professional careers of women engaged in diabetes research, education, and care.

Research Design and Methods

This study used concept mapping, a mixed-methods, multistep process, to generate a conceptual map of recommendations through the following steps: 1) identify stakeholders and develop the focus prompt, 2) generate ideas through brainstorming, 3) structure ideas through sorting and rating on priority and likelihood, 4) analyze the data and create a cluster map, and 5) interpret and use results.

Results

Fifty-two participants completed the brainstorming phase, and 24 participated in sorting and rating. The final concept map included seven clusters. Those rated as highest priority were to ensure supportive workplace culture (μ = 4.43); promote practices to achieve gender parity in hiring, workload, and promotion (μ = 4.37); and increase funding opportunities and allow extensions (μ = 4.36).

Conclusion

This study identified recommendations for institutions to better support women engaged in diabetes-related work to alleviate the long-term impact of the COVID-19 pandemic on their careers. Some areas were rated as high in priority and high in likelihood, such as ensuring a supportive workplace culture. In contrast, family-friendly benefits and policies were rated as high in priority but low in likelihood of being implemented; these may take more effort to address, including coordinated efforts within institutions (e.g., women's academic networks) and professional societies to promote standards and programs that advance gender equity in medicine.

Leveraging Implementation Science for Cardiovascular Health Equity: A Scientific Statement From the American Heart Association

Reducing cardiovascular disease disparities will require a concerted, focused effort to better adopt evidence-based interventions, in particular, those that address social determinants of health, in historically marginalized populations (ie, communities excluded on the basis of social identifiers like race, ethnicity, and social class and subject to inequitable distribution of social, economic, physical, and psychological resources). Implementation science is centered around stakeholder engagement and, by virtue of its reliance on theoretical frameworks, is custom built for addressing research-to-practice gaps. However, little guidance exists for how best to leverage implementation science to promote cardiovascular health equity. This American Heart Association scientific statement was commissioned to define implementation science with a cardiovascular health equity lens and to evaluate implementation research that targets cardiovascular inequities. We provide a 4-step roadmap and checklist with critical equity considerations for selecting/adapting evidence-based practices, assessing barriers and facilitators to implementation, selecting/using/adapting implementation strategies, and evaluating implementation success. Informed by our roadmap, we examine several organizational, community, policy, and multisetting interventions and implementation strategies developed to reduce cardiovascular disparities. We highlight gaps in implementation science research to date aimed at achieving cardiovascular health equity, including lack of stakeholder engagement, rigorous mixed methods, and equity-informed theoretical frameworks. We provide several key suggestions, including the need for improved conceptualization and inclusion of social and structural determinants of health in implementation science, and the use of adaptive, hybrid effectiveness designs. In addition, we call for more rigorous examination of multilevel interventions and implementation strategies with the greatest potential for reducing both primary and secondary cardiovascular disparities.

Does the neighborhood built environment moderate the effectiveness of a weight-loss intervention for mothers with overweight or obesity? Findings from the Healthy Eating and Active Living Taught at Home (HEALTH) study

BACKGROUND

Women of childbearing age are vulnerable to weight gain and experience a high prevalence of obesity due to pregnancy and stressors of parenthood. Lifestyle interventions such as the Healthy Eating and Active Living Taught at Home (HEALTH) study have been effective for weight loss; however, little is known about how the built environment (parks, transit, grocery stores, fast food, walkability etc.), where participants live might modify intervention effectiveness. This study examined whether characteristics of the neighborhood built environment modified effectiveness of the HEALTH study on weight loss.  METHODS: Secondary data analysis was conducted using data from HEALTH. Using GIS, buffers were built around participant addresses to capture distance to and availability of food (grocery store, convenience store, fast food) and urban design and transit (parks, street connectivity, transit) built environment characteristics. Built environment characteristics were dichotomized into low and high density and distance. Likelihood ratio tests for interaction were conducted to determine if built environment characteristics modified intervention effectiveness on Body mass index (BMI) and waist circumference (WC). Mixed effects linear regression models were then run to estimate the effect of the HEALTH intervention on weight outcomes at 24-months across both strata of built environment characteristics.  RESULTS: The analytic sample (n = 151) had baseline mean BMI 34.9 (SD = 5.8) and mean WC 46.0 cm (SD4.9). All urban design and transit and all food environment characteristics modified HEALTH effectiveness on one or both weight outcomes. The built environment modified the HEALTH intervention such that it was mostly effective for mothers residing in neighborhoods with low transit access, low street connectivity, high park access, and low access to grocery stores, convenience stores, and fast food.

CONCLUSIONS

Result show the HEALTH was most effective for women residing neighborhoods with built environment characteristics suggestive of suburban neighborhood typology. To maximize impact for mothers residing in all types of neighborhoods, future research should explore scaling up HEALTH in suburban settings, while adapting HEALTH to maximize effectiveness in compact neighborhoods most likely, urban core neighborhoods.

A case study of adapting a health insurance decision intervention from trial into routine cancer care

Objective

This study adapted Improving Cancer Patients’ Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (> 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact.

Results

Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise.

A scoping review of frameworks in empirical studies and a review of dissemination frameworks

BACKGROUND

The field of dissemination and implementation (D&I) research has grown immensely in recent years. However, the field of dissemination research has not coalesced to the same degree as the field of implementation research. To advance the field of dissemination research, this review aimed to (1) identify the extent to which dissemination frameworks are used in dissemination empirical studies, (2) examine how scholars define dissemination, and (3) identify key constructs from dissemination frameworks.

METHODS

To achieve aims 1 and 2, we conducted a scoping review of dissemination studies published in D&I science journals. The search strategy included manuscripts published from 1985 to 2020. Articles were included if they were empirical quantitative or mixed methods studies about the dissemination of information to a professional audience. Studies were excluded if they were systematic reviews, commentaries or conceptual papers, scale-up or scale-out studies, qualitative or case studies, or descriptions of programs. To achieve aim 1, we compiled the frameworks identified in the empirical studies. To achieve aim 2, we compiled the definitions from dissemination from frameworks identified in aim 1 and from dissemination frameworks identified in a 2021 review (Tabak RG, Am J Prev Med 43:337-350, 2012). To achieve aim 3, we compile the constructs and their definitions from the frameworks.

FINDINGS

Out of 6017 studies, 89 studies were included for full-text extraction. Of these, 45 (51%) used a framework to guide the study. Across the 45 studies, 34 distinct frameworks were identified, out of which 13 (38%) defined dissemination. There is a lack of consensus on the definition of dissemination. Altogether, we identified 48 constructs, divided into 4 categories: process, determinants, strategies, and outcomes. Constructs in the frameworks are not well defined.

IMPLICATION FOR D&I RESEARCH

This study provides a critical step in the dissemination research literature by offering suggestions on how to define dissemination research and by cataloging and defining dissemination constructs. Strengthening these definitions and distinctions between D&I research could enhance scientific reproducibility and advance the field of dissemination research.

A scoping review of de-implementation frameworks and models

BACKGROUND

Reduction or elimination of inappropriate, ineffective, or potentially harmful healthcare services and public health programs can help to ensure limited resources are used effectively. Frameworks and models (FM) are valuable tools in conceptualizing and guiding the study of de-implementation. This scoping review sought to identify and characterize FM that can be used to study de-implementation as a phenomenon and identify gaps in the literature to inform future model development and application for research.

METHODS

We searched nine databases and eleven journals from a broad array of disciplines (e.g., healthcare, public health, public policy) for de-implementation studies published between 1990 and June 2020. Two raters independently screened titles and abstracts, and then a pair of raters screened all full text records. We extracted information related to setting, discipline, study design, methodology, and FM characteristics from included studies.

RESULTS

The final search yielded 1860 records, from which we screened 126 full text records. We extracted data from 27 articles containing 27 unique FM. Most FM (n = 21) were applicable to two or more levels of the Socio-Ecological Framework, and most commonly assessed constructs were at the organization level (n = 18). Most FM (n = 18) depicted a linear relationship between constructs, few depicted a more complex structure, such as a nested or cyclical relationship. Thirteen studies applied FM in empirical investigations of de-implementation, while 14 articles were commentary or review papers that included FM.

CONCLUSION

De-implementation is a process studied in a broad array of disciplines, yet implementation science has thus far been limited in the integration of learnings from other fields. This review offers an overview of visual representations of FM that implementation researchers and practitioners can use to inform their work. Additional work is needed to test and refine existing FM and to determine the extent to which FM developed in one setting or for a particular topic can be applied to other contexts. Given the extensive availability of FM in implementation science, we suggest researchers build from existing FM rather than recreating novel FM.

REGISTRATION

Not registered.

Dissemination and Implementation Science in Cardiothoracic Surgery: A Review and Case Study

Dissemination and implementation (D&I) science is the practice of taking evidence-based interventions (EBI) and sustainably incorporating them in routine clinical practice. As a relatively young field, D&I techniques are underutilized in cardiothoracic surgery. This review offers an overview of D&I science from the context of the cardiothoracic surgeon. First, we provide a general introduction to D&I science and basic terminology that is used in the field. Second, to illustrate D&I techniques in a real-world example, we discuss a case study for implementing lung protective management (LPM) strategies for lung donor optimization nationally. Finally, we discuss challenges to successful implementation that are unique to cardiothoracic surgery and give several examples of EBIs that have been poorly implemented into surgical practice. We also provide examples of successful D&I interventions - including de-implementation strategies - from other surgical subspecialties. We hope that this review offers additional tools for cardiothoracic surgeons to explore when introducing EBIs into routine practice.

Social Determinants of Health Discussed with Mothers During Personal Visits Before and During the COVID-19 Pandemic

Purpose: This report describes the social determinants of health (SDOH) discussed during personal visits at the time leading up to and during the first 4 months of the pandemic from families across the United States. Methods: This is a secondary analysis from a cluster randomized trial that embeds Healthy Eating and Active Living Taught at Home within Parents as Teachers (PAT). PAT is a national organization serving families prenatal through kindergarten, delivered by parent educators. After parent educators complete visits with mothers in the trial, they complete brief surveys including the question "Did issues with any of these come up during the visit?" with yes/no options for "Transportation," "Housing," "Food insecurity," "Childcare," "Financial constraint," or "Other." Results: Among the 60 mothers with visit records in the months before and during (March-July 2020) COVID-19, 55% identified as Hispanic or Latino and 52% reported food insecurity at baseline. During COVID-19, financial constraints and other SDOH were as common as they were before COVID-19; childcare issues were discussed less frequently and food security was discussed more frequently. When comparing the number of SDOH parent educators reported discussing with mothers in visits that took place before COVID-19 with the number of SDOH discussed in visits during COVID-19, the number of SDOH increased for 41% for mothers identifying as Hispanic or Latino and only 8% for non-Hispanic or Latino mothers. Conclusions: This study can help build an understanding of how COVID-19 is impacting families, and how these impacts may be inequitable. Clinical Trial Registration Number: NCT03758638.

Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review

OBJECTIVES

The purpose of this review was to use RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) to assess the extent to which weight gain prevention studies targeting young adults reported on elements of external validity.

DESIGN

Systematic review.

ELIGIBILITY CRITERIA

Articles of interest included a lifestyle/behavioral intervention targeting weight gain prevention. Eligibility criteria included the following: study design of randomized controlled trials, quasi-randomized control trials, or natural experiments; average participant age between 18 and 35 years; study duration of at least 12 months; and published in English between January 2008 and May 2018. Studies had to report weight or body mass index as a measured outcome and were excluded if they were paired with smoking cessation programs, were conducted in specific groups (ie, pregnant women, breast cancer survivors), or were follow-ups to weight loss studies.

STUDY SELECTION

After removing duplicates, the search yielded 11426 articles. Titles and abstracts were screened by 1 reviewer; 144 articles were assessed in a full-text review by 2 reviewers. Discrepancies were resolved by consensus. Nine studies (13 articles) were included in the review.

MAIN OUTCOMES MEASURES

Reported elements of the RE-AIM framework.

RESULTS

A total of 9 studies met the selection criteria. All studies lacked full reporting on external validity elements. Of the total of 60 RE-AIM reporting criteria, 8 were reported by all 9 studies, 26 criteria were reported by fewer than 4 studies, and 22 criteria were not reported by any of the studies.

DISCUSSION

There remains inadequate reporting of elements of external validity and generalizability in weight gain prevention studies. This is a significant scientific constraint that limits the information required to disseminate and implement prevention of weight gain interventions for population impact. Standardized reporting may be needed to ensure results that demonstrate not only internal validity but also external validity and generalizability are needed to promote public health impact.

Expanding Implementation Research to Prevent Chronic Diseases in Community Settings

Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.

Roles dissemination and implementation scientists can play in supporting research teams

The field of dissemination and implementation (D&I) science is rapidly growing, with many scientists seeking to apply D&I science to enhance and expand the impact of their work. As the D&I field grows and collaborations of implementation scientists with other fields flourish, a description for the roles for D&I scientists as they collaborate with researchers from other fields could be beneficial. This paper exemplifies how the D&I scientist/researcher collaborative process might work and important elements to consider in doing so, as well as provide an outline on how collaborations might progress for different project needs. This is discussed through example scenarios to consider an implementation scientists' engagement in a research project and describe potential roles for implementation scientists in supporting research teams. We then discuss characteristics to consider when incorporating a D&I expert into a team and considerations in navigating the scenarios.

Neighborhood Perceptions Among Pregnant African American Women in St. Louis, Missouri, Before and After the Shooting of Michael Brown

Purpose: This study aims to examine perceptions of neighborhood quality and safety before and after the death of Michael Brown and the unrest that followed. Methods: In this secondary analysis of baseline data from one site in The Lifestyle Interventions for Expectant Moms (LIFE-Moms) Consortium, pregnant African American women in the St. Louis region completed a survey of neighborhood perceptions. Logistic regression was used to explore associations between perceptions among those completing baseline surveys and entering the study before and after August 9, 2014 (range: 2012-2015), adjusted for demographic characteristics. Results: Of 267 participants, half (n=134) completed the survey after August 9, 2014. Thirty-four percent of participants completing the survey after this date felt "The crime rate in my neighborhood makes it unsafe to go on walks during the day" compared with 21% of those completing the survey before (adjusted odds ratio=2.0, 95% confidence interval: 1.1-3.7). There were no consistently significant differences in demographic characteristics or in the remaining 16 neighborhood items. Conclusions: This study is an example of how an unexpected shift in the community context in the wake of a profound event may impact health behaviors and outcomes in a measurable way. Clinical Trials Registration: NCT01768793.

Assessing Organizational Supports for Evidence-Based Decision Making in Local Public Health Departments in the United States: Development and Psychometric Properties of a New Measure

CONTEXT

Fostering evidence-based decision making (EBDM) within local public health departments and among local health department (LHD) practitioners is crucial for the successful translation of research into public health practice to prevent and control chronic disease.

OBJECTIVE

The purpose of this study was to identify organizational supports for EBDM within LHDs and determine psychometric properties of a measure of organizational supports for EBDM in LHDs.

DESIGN

Cross-sectional, observation study.

SETTING

Local public health departments in the United States.

PARTICIPANTS

Local health department practitioners (N = 376) across the United States participated in the study.

MAIN OUTCOME MEASURES

Local health department practitioners completed a survey containing 27 items about organizational supports for EBDM. Most items were adapted from previously developed surveys, and input from researchers and practitioners guided survey development. Confirmatory factor analysis was used to test and refine the psychometric properties of the measure.

RESULTS

The final solution included 6 factors of 22 items: awareness of EBDM (3 items), capacity for EBDM (7 items), resources availability (3 items), evaluation capacity (3 items), EBDM climate cultivation (3 items), and partnerships to support EBDM (3 items). This factor solution achieved acceptable fit (eg, Comparative Fit Index = 0.965). Logistic regression models showed positive relationships between the 6 factors and the number of evidence-based interventions delivered.

CONCLUSIONS

This study identified important organizational supports for EBDM within LHDs. Results of this study can be used to understand and enhance organizational processes and structures to support EBDM to improve LHD performance and population health. Strong measures are important for understanding how LHDs support EBDM, evaluating interventions to improve LHD capacity, and to guide programmatic and policy efforts within LHDs.

Pilot test of an interactive obesity treatment approach among employed adults in a university medical billing office

Background

There is a need for workplace programs promoting healthy eating and activity that reach low-wage employees and are scalable beyond the study site. Interventions designed with dissemination in mind aim to utilize minimal resources and to fit within existing systems. Technology-based interventions have the potential to promote healthy behaviors and to be sustainable as well as scalable. We developed an interactive obesity treatment approach (iOTA), to be delivered by SMS text messaging, and therefore accessible to a broad population. The aim of this pilot study was to evaluate participant engagement with, and acceptability of, this iOTA to promote healthy eating and activity behaviors among low-wage workers with obesity.

Methods

Twenty participants (self-reporting body mass index ≥ 30 kg/m²) of a single workgroup employed by a university medical practice billing office had access to the full intervention and study measures and provided feedback on the experience. Height and weight were measured by trained research staff at baseline. Each participant was offered a quarterly session with a health coach. Measured weight and a self-administered survey, including dietary and activity behaviors, were also collected at baseline, 3, 6, 12, 18, and 24 months. Participant engagement was assessed through responsiveness to iOTA SMS text messages throughout the 24-month pilot. A survey measure was used to assess satisfaction with iOTA at 3 months. Due to the small sample size and pilot nature of the current study, we conducted descriptive analyses. Engagement, weight change, and duration remaining in coaching are presented individually for each study participant.

Results

The pilot was originally intended to last 3 months, but nearly all participants requested to continue; we thus continued for 24 months. Most (14/20) participants remained in coaching for 24 months. At the 3-month follow-up, eight (47%) of the remaining 17 participants had lost weight; by 24 months, five (36%) of the remaining 14 participants had lost weight (one had bariatric surgery). Participants reported very high satisfaction.

Conclusions

This pilot provides important preliminary results on acceptability and participant engagement with iOTA, which has significant potential for dissemination and sustainability.

Local Health Department Accreditation Is Associated With Organizational Supports for Evidence-Based Decision Making

Introduction: Recent studies show that health department accreditation from the U.S. Public Health Accreditation Board (PHAB) drives performance management and quality improvement. PHAB standards call for agencies to use evidence in decision making. It is unknown whether accreditation is associated with organizational supports for evidence-based decision making (EBDM). Self-report data from a 2017 survey of U.S. local health departments were analyzed to test relationships of accreditation status with organizational supports for EBDM.

Methods: A cross-sectional survey was conducted in this observational study. A total of 579 local health departments were invited to complete an online survey; 350 (60.4%) provided complete data for the present study. The dependent variables were six factors of organizational supports for EBDM previously validated through confirmatory factor analyses. Accreditation status (PHAB-accredited, preparing, not preparing) was the independent variable of interest. Logistic regression analyses controlled for governance (presence of a local board of health; state, local, or shared state and local governance) and jurisdiction population size.

Results: PHAB-accredited health departments were more likely to report higher capacity for EBDM, resource availability for EBDM, and evaluation capacity than health departments that reported not yet preparing for accreditation. Health departments that reported preparing for PHAB accreditation showed a non-significant pattern of higher perceived supports for EBDM compared to departments not preparing for accreditation.

Conclusion: PHAB standards and the accreditation process may help stimulate health department organizational supports for EBDM.

Weight gain prevention content delivered to mothers: Lessons from an intervention embedded in a community organization

BACKGROUND

Transparent reporting of the intervention content study participants receive is particularly important for dissemination and implementation of evidence-based interventions to address obesity. This study explores intervention delivery and perceptions of content when an intervention is embedded within an organization's usual practice and associations with weight outcomes.

METHODS

This is a secondary analysis from the Healthy Eating and Active Living Taught at Home (HEALTH) randomized trial. HEALTH is a weight gain prevention intervention embedded within a national home visiting programme (Parents as Teachers, PAT). To be consistent with PAT practice, HEALTH has a suggested but also flexible home visit structure. Therefore, the number and frequency of home visits are determined by the family's needs and preferences based on the parent educator's professional judgement. The proportion of participants who received each curriculum core lesson was explored among the 105 families randomized to the HEALTH intervention group, as were mean parent educator perception ratings of the visits (5-point Likert-type scale). A chi-square test was used to examine the association between utilization (ie, low: 1-6, middle: 7-12, or high: 13-18 visits) category and weight maintenance.

RESULTS

Mothers received on average 13.3 (standard deviation 6.2) core visits. Mean parent educator perception of the mothers' response (out of 5) ranged from 3.99 to 4.27; educators' perception of their own experience with the lesson ranged from 4.13 to 4.34. Among mothers who maintained their weight, 13% were low, 22% were middle, and 65% were high utilizers, while among mothers who gained weight, 3%, 31%, and 67% were low, middle, and high utilizers, respectively; this difference was not statistically significant.

CONCLUSIONS

This study identified wide variation in the visits families received from the curriculum but minimal variation in visit perceptions. Future studies could explore whether there are optimal patterns for visit content, associated with successful outcomes.

Upper Limb Performance in Daily Life Improves Over the First 12 Weeks Poststroke

Background. Upper limb (UL) performance, or use, in daily life is complex and likely influenced by many factors. While the recovery trajectory of UL impairment poststroke is well documented, little is known about the recovery trajectory of sensor-measured UL performance in daily life early after stroke and the potential moderating role of psychosocial factors. Objective. To examine the recovery trajectory of UL performance within the first 12 weeks poststroke and characterize the potential moderating role of belief, confidence, and motivation on UL performance. Methods. This was a longitudinal, prospective cohort study quantifying UL performance and related psychosocial factors early after stroke. UL performance was quantified via bilateral, wrist-worn accelerometers over 5 assessment sessions for 24 hours. Belief, confidence, and motivation to use the paretic UL, and self-perceived barriers to UL recovery were quantified via survey. Change in 4 accelerometer variables and the moderating role of psychosocial factors was tested using hierarchical linear modeling. The relationship between self-perceived barriers and UL performance was tested via Spearman rank-order correlation analysis. Results. UL performance improved over the first 12 weeks after stroke. Belief, confidence, and motivation did not moderate UL performance over time. There was a negative relationship between UL performance and self-perceived barriers to UL recovery at week 2, which declined over time. Conclusions. Sensor-measured UL performance can improve early after stroke. Early after stroke, rehabilitation interventions may not need to directly target belief, confidence, and motivation but may instead focus on reducing self-perceived barriers to UL recovery.

Belief, Confidence, and Motivation to Use the Paretic Upper Limb in Daily Life Over the First 24 Weeks After Stroke

BACKGROUND AND PURPOSE

The recovery patterns of upper limb (UL) impairment after stroke are established. Psychosocial factors such as belief that paretic UL recovery is possible, confidence, and motivation to use the paretic UL in everyday tasks are unexplored early after stroke. The purpose of this exploratory study was to characterize belief, confidence, and motivation to use the paretic UL in daily life, and self-perceived barriers to UL recovery over the first 24 weeks after stroke.

METHODS

This was a longitudinal cohort study (N = 30) with 8 assessment sessions over the first 24 weeks after stroke. Belief, confidence, and motivation to use the paretic UL and self-perceived barriers were quantified via survey and analyzed using descriptive statistics. Change in the number of self-perceived barriers between weeks 2 and 24 was tested using a paired-samples t test. The relationship between UL capacity, depressive symptomatology, cognition, and each psychosocial factor was examined using Spearman rank-order correlation analyses.

RESULTS

Twenty-two participants completed all study assessments. Belief, confidence, and motivation were high across the 24 weeks, with little variation. There was no difference between the average number of barriers from weeks 2 to 24. There was no relationship between the clinical measures and psychosocial factors at week 2, 12, or 24.

DISCUSSION AND CONCLUSIONS

High levels of belief, confidence, and motivation appear consistent over the first 6 months after stroke. The lack of correlations between psychosocial factors and clinical measures suggests belief, confidence, and motivation may not be vulnerable to functional status early after stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A283).

Disseminating and implementing a lifestyle-based healthy weight program for mothers in a national organization: a study protocol for a cluster randomized trial

Background

Excessive weight gain among young adult women age 18–45 years is an alarming and overlooked trend that must be addressed to reverse the epidemics of obesity and chronic disease. During this vulnerable period, women tend to gain disproportionally large amounts of weight compared to men and to other life periods. Healthy Eating and Active Living Taught at Home (HEALTH) is a lifestyle modification intervention developed in partnership with Parents as Teachers (PAT), a national home visiting, community-based organization with significant reach in this population. HEALTH prevented weight gain, promoted sustained weight loss, and reduced waist circumference. PAT provides parent–child education and services free of charge to nearly 170,000 families through up to 25 free home visits per year until the child enters kindergarten.

Methods

This study extends effectiveness findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation (D&I) of HEALTH across three levels (mother, parent educator, PAT site). The trial will evaluate the effect of HEALTH and the HEALTH training curriculum (implementation strategy) on weight among mothers with overweight and obesity across the USA (N = 252 HEALTH; N = 252 usual care). Parent educators from 28 existing PAT sites (14 HEALTH, 14 usual care) will receive the HEALTH training curriculum through PAT National Center, using PAT’s existing training infrastructure, as a continuing education opportunity. An extensive evaluation, guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation) at the parent educator level. The Conceptual Framework for Implementation Research will characterize determinants that influence HEALTH D&I at three levels: mother, parent educator, and PAT site to enhance external validity (reach and maintenance).

Discussion

Embedding intervention content within existing delivery channels can help expand the reach of evidence-based interventions. Interventions, which have been adapted, can still be effective even if the effect is reduced and can still achieve population impact by reaching a broader set of the population. The current study will build on this to test not only the effectiveness of HEALTH in real-world PAT implementation nationwide, but also elements critical to D&I, implementation outcomes, and the context for implementation.

Trial registration

https://ClinicalTrials.gov, NCT03758638. Registered 29 November 2018

Electronic supplementary material

The online version of this article (10.1186/s13012-019-0916-0) contains supplementary material, which is available to authorized users.

Design of a randomized trial testing a multi-level weight-control intervention to reduce obesity and related health conditions in low-income workers

Weight-control is a major public health focus for preventing multiple obesity-related health conditions. While clinic-based intensive lifestyle interventions are successful, low-socioeconomic-status (SES) populations, which have a higher burden of obesity, are difficult to reach; thus, the workplace offers a useful setting to target low-SES workers. The current paper presents the design of a study testing a workplace intervention aimed at low-SES employees. Partnering with a large healthcare system and affiliated university, this project will test an innovative multi-level intervention ("Working for You") adapted from existing group- and individual-level intervention models to promote healthy weight among low-wage workers. The individual-level component is an interactive obesity treatment approach (iOTA) program that involves assessment of behavior risks, collaborative goal-setting with a health coach, and interactive SMS text-messages for ongoing support and self-monitoring. This mHealth intervention is embedded in the group-level component, a workplace participatory program that involves worker teams engaged in the design and implementation of interventions to change their workplace environments. These nested interventions are being tested in a group-randomized trial among 22 work groups (~1000 total workers, ~300 workers with obesity). The primary outcome will be program effects on weight at 2-year follow-up, compared to control, and the secondary outcomes will be effects on diet and physical activity; iOTA adherence, process measures, and work environment/support will also be examined. This pragmatic clinical trial will test scalable interventions that can be translated to other work settings to reduce obesity and related health risks among low-SES workers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02934113.

The Impact of a Healthy Weight Intervention Embedded in a Home-Visiting Program on Children's Weight and Mothers' Feeding Practices

OBJECTIVE

To examine whether a healthy weight intervention embedded in the Parents as Teachers (PAT) home visiting program, which was previously found to improve mothers' body mass index (BMI) and obesity-related behaviors, changed the BMI of preschool children or maternal feeding practices.

METHODS

This stratified randomized trial included preschool-aged children at risk for overweight whose mothers were overweight or had obesity (n = 179). The Healthy Eating and Active Living Taught at Home (HEALTH) intervention was based on the Diabetes Prevention Program. Differences were examined using repeated-measures mixed-ANOVA models.

RESULTS

Compared with PAT usual care, the HEALTH intervention had no effect on children's BMI or maternal feeding practices. However, combined analyses showed that children's BMI percentile decreased (P  = .007), BMI z-scores were maintained (P  = .19), and 3 of 8 feeding practices improved over time (P < .05).

CONCLUSIONS AND IMPLICATIONS

Additional research is needed to assess the effectiveness of PAT to prevent preschool-age obesity using rigorous designs (eg, group-randomized trials) and to identify its active components. HEALTH is ready to be scaled up to prevent maternal weight gain through embedding within the national PAT program.

Developing priorities to achieve health equity through diabetes translation research: a concept mapping study

INTRODUCTION

The goal of diabetes translation research is to advance research into practice and ensure equitable benefit from scientific evidence. This study uses concept mapping to inform and refine future directions of diabetes translation research with the goal of achieving health equity in diabetes prevention and control.

RESEARCH DESIGN AND METHODS

This study used concept mapping and input from a national network of diabetes researchers and public health practitioners. Concept mapping is a mixed-method, participant-based process. First, participants generated statements by responding to a focus prompt ("To eliminate disparities and achieve health equity in the prevention and treatment of diabetes, research should…"). Participants then sorted statements by conceptual similarity and rated each statement on importance and feasibility (Likert scale of 1-5). A cluster map was created using multidimensional scaling and hierarchical cluster analysis; statements were plotted by average importance and feasibility.

RESULTS

Ten clusters were identified containing between 6 and 12 statements from 95 total generated statements. The ranges of average importance and feasibility ratings for clusters were fairly high and narrow (3.62-4.09; 3.10-3.93, respectively). Clusters with the most statements in the "go-zone" quadrant (above average importance/feasibility) were community and partner engagement (n=7), dissemination and implementation principles (n=4), and enrichment and capacity building (n=4). Clusters with the most statements in the "innovative-targets" quadrant (above average importance, below average feasibility) included next generation interventions (n=6), policy approaches (n=4), and interventions for specific populations (n=4).

CONCLUSIONS

This study created a framework of 10 priority areas to guide current and future efforts in diabetes translation research to achieve health equity. Themes rated as highly important and feasible provide the basis to evaluate current research support. Future efforts should explore how to best support innovative-targets, those rated highly important but less feasible.

Development of a scalable weight loss intervention for low-income workers through adaptation of interactive obesity treatment approach (iOTA)

BACKGROUND

Describing how and why an evidence-based intervention is adapted for a new population and setting using a formal evaluation and an adaptation framework can inform others seeking to modify evidence-based weight management interventions for different populations or settings. The Working for You intervention was adapted, to fit a workplace environment, from Be Fit Be Well, an evidence-based intervention that targets weight-control and hypertension in patients at an outpatient clinic. Workplace-based efforts that promote diet and activity behavior change among low-income employees have potential to address the obesity epidemic. This paper aims to explicitly describe how Be Fit Be Well was adapted for this new setting and population.

METHODS

To describe and understand the worksite culture, environment, and policies that support or constrain healthy eating and activity in the target population, we used qualitative and quantitative methods including key informant interviews, focus groups, and a worker survey; these data informed intervention adaptation. We organized the adaptations made to Be Fit Be Well using an adaptation framework from implementation science.

RESULTS

The adapted intervention, Working for You, maintains the theoretical premise and evidence-base underpinning Be Fit Be Well. However, it was modified in terms of the means of delivery (i.e., rather than using interactive voice response, Working for You employs automated SMS text messaging), defined as a modification to context by the adaptation framework. The adaptation framework also includes modifications to content; in this case the behavioral goals were modified for the target population based on updated science related to weight loss and to target a workplace population (e.g., a goal to avoiding free food at work).

CONCLUSIONS

If effective, this scalable and relatively inexpensive intervention can be translated to other work settings to reduce obesity and diabetes risk among low-SES workers, a group with a higher prevalence of these conditions. Using a formal evaluation and framework to guide and organize how and why an evidence-based intervention is adapted for a new population and setting can push the field of intervention research forward.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02934113 ; Received: October 12, 2016; Updated: November 7, 2017.

Impact of a Healthy Weight Intervention Embedded Within a National Home Visiting Program on the Home Food Environment

Purpose: To determine whether a lifestyle intervention embedded within Parents as Teachers (PAT), a national child development and parenting home visiting program, helped families make food-related home environment changes.

Design: Secondary data analysis of a stratified randomized pragmatic trial. (Trial Registration: This study is registered at www.clinicaltrials.gov NCT01567033).

Setting: Participant homes in St. Louis, Missouri.

Subjects: Women (n = 179 with pre-post data, of 230 with baseline) participating in standard PAT, with overweight or obesity, and at least one preschool child with BMI percentile ≥60%.

Intervention: PAT + Healthy Eating and Active Living Taught at Home (HEALTH), embedded elements of the Diabetes Prevention Program within the standard PAT curriculum. PAT + HEALTH addressed specific behaviors that impact caloric intake (e.g., sugar-sweetened beverages), focusing on behavioral and environmental strategies. Consistent with PAT practice, the frequency, number, and focus (i.e., time spent on intervention components) of home visits were determined by the family's needs; dose structure was flexible [on average intervention: 23 (SD = 9), usual care: 13 (SD = 6) visits].

Measures: Food availability/accessibility and distractions in the home were assessed with items drawn largely from the HomeSTEAD Survey.

Analysis: Generalized estimating equations (GEEs) were used to test equality of changes between baseline and 24 months in the intervention and usual care groups.

Results: The only significant difference in the pattern of change between usual care and intervention was soda availability/accessibility (p = 0.013).

Conclusion: This embedded intervention successfully reduced availability/accessibility of sugar-sweetened beverages in the home. However, given the limited impact on other food-related home environment factors, future interventions could seek to more effectively intervene on all aspects of the home environment.

A formative study to understand perspectives of families eligible for a pediatric obesity program: a qualitative study

Background

Raising Well^® (RW) was initiated in 2015 by Envolve PeopleCare™ at the request of health plans seeking a solution to work with families on Medicaid that have a child with overweight or obesity. RW uses expert clinical coaches via phone contact to deliver an educational intervention promoting lifestyle change to families with at least one overweight or obese child in an eligible Medicaid health plan. This gives RW significant potential for reach and population impact. This project aimed to understand how to maximize this impact by exploring perspectives of RW, using a conceptual framework informed by the Conceptual Model of Implementation Research, including assessment of the feasibility, acceptability, and appropriateness of RW; determining satisfaction among those experiencing coaching; identifying reasons individuals do not participate; and developing recommendations to enhance interest and participation.

Methods

Semi-structured interviews were conducted with 70 RW-eligible families across four states, who were described as: active participants, respondents who dropped or stopped RW, and RW non-participants. Following the interviews, the transcripts were coded inductively and deductively using a grounded theory approach, considering themes from the conceptual framework; themes also emerged from the data.

Results

From this sample, 19 families reported to be active coaching participants, 24 had dropped coaching, and 27 were RW non-participants. A number of themes were identified. Feasibility themes included coaches’ flexibility and willingness to work with the family’s schedule. Acceptability themes suggest providing actionable strategies tailored to the family’s context and needs, beyond just nutrition information and tips, early in the coaching relationship so the family perceives a benefit for continued participation. With regard to appropriateness, families were also interested in other methods of communication including email, texting, and in person visits. Access to resources for activity and healthy eating in their local community was also recommended.

Conclusions

RW has the potential to improve health and promote wellness. To enhance the impact of this program, RW could incorporate these findings to promote feasibility, acceptability, and appropriateness and improve program implementation. Strategies may include modifying the information provided or the mode of delivering the information.

Does Availability of Worksite Supports for Physical Activity Differ by Industry and Occupation?

PURPOSE

To explore combinations of worksite supports (WSS) for physical activity (PA) that may assist employees in meeting PA recommendations and to investigate how availability of WSS differs across industries and occupations.

DESIGN

Cross-sectional.

SETTING

Several Missouri metropolitan areas.

PARTICIPANTS

Adults employed >20 h/wk outside the home.

MEASURES

Survey utilized existing self-reported measures (eg, presence of WSS for PA) and the International Physical Activity Questionnaire.

ANALYSIS

Logistic regression was conducted for 2 outcome variables: leisure and transportation PA. Independent variables included 16 WSS. Of particular interest were interaction effects between WSS variables. Analyses were stratified by 5 occupation and 7 industry types.

RESULTS

Overall, 2013 people completed the survey (46% response rate). Often, availability of 1 WSS did not increase the likelihood of meeting PA recommendations, but several pairs of WSS did. For example, in business occupations, the odds of meeting PA recommendations through transportation PA increased when employees had access to showers and incentives to bike/walk (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.16-2.22); showers and maps (OR = 1.25; 1.02-1.55); maps and incentives to bike/walk (OR = 1.48; 1.04-2.12).

CONCLUSION

Various combinations of WSS may increase the likelihood that employees will meet PA recommendations. Many are of low or no cost, including flexible time for exercise and maps of worksite-adjacent walk/bike routes. Findings may be instructive for employers seeking to improve employee health through worksite PA.

Variation in Research Designs Used to Test the Effectiveness of Dissemination and Implementation Strategies: A Review

Background

The need for optimal study designs in dissemination and implementation (D&I) research is increasingly recognized. Despite the wide range of study designs available for D&I research, we lack understanding of the types of designs and methodologies that are routinely used in the field. This review assesses the designs and methodologies in recently proposed D&I studies and provides resources to guide design decisions.

Methods

We reviewed 404 study protocols published in the journal Implementation Science from 2/2006 to 9/2017. Eligible studies tested the efficacy or effectiveness of D&I strategies (i.e., not effectiveness of the underlying clinical or public health intervention); had a comparison by group and/or time; and used ≥1 quantitative measure. Several design elements were extracted: design category (e.g., randomized); design type [e.g., cluster randomized controlled trial (RCT)]; data type (e.g., quantitative); D&I theoretical framework; levels of treatment assignment, intervention, and measurement; and country in which the research was conducted. Each protocol was double-coded, and discrepancies were resolved through discussion.

Results

Of the 404 protocols reviewed, 212 (52%) studies tested one or more implementation strategy across 208 manuscripts, therefore meeting inclusion criteria. Of the included studies, 77% utilized randomized designs, primarily cluster RCTs. The use of alternative designs (e.g., stepped wedge) increased over time. Fewer studies were quasi-experimental (17%) or observational (6%). Many study design categories (e.g., controlled pre-post, matched pair cluster design) were represented by only one or two studies. Most articles proposed quantitative and qualitative methods (61%), with the remaining 39% proposing only quantitative. Half of protocols (52%) reported using a theoretical framework to guide the study. The four most frequently reported frameworks were Consolidated Framework for Implementing Research and RE-AIM (n = 16 each), followed by Promoting Action on Research Implementation in Health Services and Theoretical Domains Framework (n = 12 each).

Conclusion

While several novel designs for D&I research have been proposed (e.g., stepped wedge, adaptive designs), the majority of the studies in our sample employed RCT designs. Alternative study designs are increasing in use but may be underutilized for a variety of reasons, including preference of funders or lack of awareness of these designs. Promisingly, the prevalent use of quantitative and qualitative methods together reflects methodological innovation in newer D&I research.

Patterns and correlates of use of evidence-based interventions to control diabetes by local health departments across the USA

OBJECTIVE

The nearly 3000 local health departments (LHDs) nationwide are the front line of public health and are positioned to implement evidence-based interventions (EBIs) for diabetes control. Yet little is currently known about use of diabetes-related EBIs among LHDs. This study used a national online survey to determine the patterns and correlates of the Centers for Disease Control and Prevention Community Guide-recommended EBIs for diabetes control in LHDs.

RESEARCH DESIGN AND METHODS

A cross-sectional study was conducted to survey a stratified random sample of LHDs regarding department characteristics, respondent characteristics, evidence-based decision making within the LHD, and delivery of EBIs (directly or in collaboration) within five categories (diabetes-related, nutrition, physical activity, obesity, and tobacco). Associations between delivering EBIs and respondent and LHD characteristics and evidence-based decision making were explored using logistic regression models.

RESULTS

Among 240 LHDs there was considerable variation among the EBIs delivered. Diabetes prevalence in the state was positively associated with offering the Diabetes Prevention Program (OR=1.28 (95% CI 1.02 to 1.62)), diabetes self-management education (OR=1.32 (95% CI 1.04 to 1.67)), and identifying patients and determining treatment (OR=1.27 (95% CI 1.05 to 1.54)). Although all organizational supports for evidence-based decision making factors were related in a positive direction, the only significant association was between evaluation capacity and identifying patients with diabetes and determining effective treatment (OR=1.54 (95% CI 1.08 to 2.19)).

CONCLUSION

Supporting evidence-based decision making and increasing the implementation of these EBIs by more LHDs can help control diabetes nationwide.

Adoption and sustained use of cleaner cooking fuels in rural India: a case control study protocol to understand household, network, and organizational drivers

Background

Implementing efficient stoves and clean fuels in low and middle-income countries are critical for improving health of poor women and children and improve the environment. Cleaner biomass stoves, however, perform poorly against the World Health Organization’s indoor air quality guidelines. This has shifted the focus to systematic dissemination and implementation of cleaner cooking systems such as liquefied petroleum gas (LPG) among poor communities. Even when there is some uptake of LPG by poor communities, its sustained use has been low. Concurrent use of LPG with traditional biomass cookstoves compromises reductions in household air pollution and limits health and environmental dividends. Therefore understanding key drivers of adoption and sustained implementation of clean fuels among the poor is critical. There is a significant gap, however, in the research to understand determinants and sustained exclusive use of clean fuels in rural poor communities.

Methods/design

Using a case control study design, this study will explore the impact of affordability, accessibility, and awareness on adoption and sustained use of LPG among rural poor communities of India. The study uses a multistage random sampling to collect primary data from 510 households. Case group or LPG adopters constitute 255 households while control group or non-LPG adopters constitute the remaining 255 households. The study will deploy sophisticated stove use monitoring sensors in each of the stoves in 100 case group households to monitor stove use and stacking behavior (using clean and traditional systems of cooking) of participants for 12 months. Moreover, this will be the first study to explore the impact of personal social networks striated by gender on LPG adoption. This study is guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) implementation science evaluation framework.

Discussion

Lessons from this study will feed into a larger discussion on developing a pro-poor strategy to foster uptake and sustained use of cleaner cooking systems such as LPG. Understanding the determinants of adoption and sustained use of cleaner cooking systems through the RE-AIM framework will expand our insights on implementation of cleaner cooking systems among poor communities and will advance implementation science in the clean cooking sector. A thorough study of such implementation strategies is crucial to realize multiple UN Sustainable Development Goals on global health, climate change, and energy security.

Driven to Support: Individual- and County-Level Factors Associated With Public Support for Active Transportation Policies

PURPOSE

To assess predictors of stated support for policies promoting physically active transportation.

DESIGN

Cross-sectional.

SETTING

US counties selected on county-level physical activity and obesity health status.

PARTICIPANTS

Participants completing random-digit dialed telephone survey (n = 906).

MEASURES

Survey measures assessed stated support for 5 policies to promote physically active transportation, access to active transportation facilities, and time spent in a car. County-level estimates included household car dependence and funding for bicycle-pedestrian projects.

ANALYSIS

Multivariable generalized linear mixed models using binary distribution and logit link, accounting for clustering within county.

RESULTS

Respondents supported policies for accommodating bicyclists and pedestrians through street improvements (89%), school active transportation programs (75%), employer-funded active commuting incentives (67%), and allocation of public funding (68%) and tax support (56%) for building and maintaining public transit. Residents spending >2 h/d (vs <0.7 hours) in cars were more likely to support street (odds ratio [OR]: 1.87; confidence interval [CI]: 1.09-3.22) and public transit (OR: 1.85; CI: 1.24-2.77) improvements. Residents in counties investing >$1.6 million in bicycle and pedestrian improvements expressed greater support for funding (OR: 1.71; CI: 1.04-2.83) and tax increases (OR: 1.73; CI: 1.08-2.75) for transit improvements compared to those with lower prior investments (<$276 100).

CONCLUSION

Support for policies to enable active transportation is higher where relevant investments in active transportation infrastructure are large (>$1.6 M), public transit is nearby, and respondents drive >2 h/d.

Enhancing evidence-based diabetes and chronic disease control among local health departments: a multi-phase dissemination study with a stepped-wedge cluster randomized trial component

BACKGROUND

The rates of diabetes and prediabetes in the USA are growing, significantly impacting the quality and length of life of those diagnosed and financially burdening society. Premature death and disability can be prevented through implementation of evidence-based programs and policies (EBPPs). Local health departments (LHDs) are uniquely positioned to implement diabetes control EBPPs because of their knowledge of, and focus on, community-level needs, contexts, and resources. There is a significant gap, however, between known diabetes control EBPPs and actual diabetes control activities conducted by LHDs. The purpose of this study is to determine how best to support the use of evidence-based public health for diabetes (and related chronic diseases) control among local-level public health practitioners.

METHODS/DESIGN

This paper describes the methods for a two-phase study with a stepped-wedge cluster randomized trial that will evaluate dissemination strategies to increase the uptake of public health knowledge and EBPPs for diabetes control among LHDs. Phase 1 includes development of measures to assess practitioner views on and organizational supports for evidence-based public health, data collection using a national online survey of LHD chronic disease practitioners, and a needs assessment of factors influencing the uptake of diabetes control EBPPs among LHDs within one state in the USA. Phase 2 involves conducting a stepped-wedge cluster randomized trial to assess effectiveness of dissemination strategies with local-level practitioners at LHDs to enhance capacity and organizational support for evidence-based diabetes prevention and control. Twelve LHDs will be selected and randomly assigned to one of the three groups that cross over from usual practice to receive the intervention (dissemination) strategies at 8-month intervals; the intervention duration for groups ranges from 8 to 24 months. Intervention (dissemination) strategies may include multi-day in-person workshops, electronic information exchange methods, technical assistance through a knowledge broker, and organizational changes to support evidence-based public health approaches. Evaluation methods comprise surveys at baseline and the three crossover time points, abstraction of local-level diabetes and chronic disease control program plans and progress reports, and social network analysis to understand the relationships and contextual issues that influence EBPP adoption.

TRIAL REGISTRATION

ClinicalTrial.gov, NCT03211832.

Opportunities for Promoting Physical Activity in Rural Communities by Understanding the Interests and Values of Community Members

PURPOSE

Physical activity (PA) has well-established health benefits, but most Americans do not meet national guidelines. In southeastern Missouri, trails have been developed to increase rates of PA. Although this has had success, broad-scale interventions will be needed to improve rates further. In this study, we surveyed residents of southeastern Missouri to identify ways to improve rates of PA.

METHODS

We conducted a telephone survey in 2015 of adults (n = 524) from eight rural Missouri towns that had walking trails, regarding their activities and interests.

FINDINGS

Forty percent of respondents reported both walking and meeting PA recommendations, 29% reported walking but not meeting PA recommendations, and the remainder did not walk or did not answer. Respondents who used the trails were significantly more likely to meet PA recommendations (odds ratio = 2.7; 95% confidence interval = 1.7, 4.5). Certain values and interests that may encourage PA or draw people to trails were common.

CONCLUSIONS

The group that walked but did not meet PA recommendations would be the ideal group to target for intervention, which could focus on their reported values and interests (e.g., personal relationships, being outdoors). Use of walking trails was associated with meeting PA recommendations.

Assessing citation networks for dissemination and implementation research frameworks

BACKGROUND

A recent review of frameworks used in dissemination and implementation (D&I) science described 61 judged to be related either to dissemination, implementation, or both. The current use of these frameworks and their contributions to D&I science more broadly has yet to be reviewed. For these reasons, our objective was to determine the role of these frameworks in the development of D&I science.

METHODS

We used the Web of Science™ Core Collection and Google Scholar™ to conduct a citation network analysis for the key frameworks described in a recent systematic review of D&I frameworks (Am J Prev Med 43(3):337-350, 2012). From January to August 2016, we collected framework data including title, reference, publication year, and citations per year and conducted descriptive and main path network analyses to identify those most important in holding the current citation network for D&I frameworks together.

RESULTS

The source article contained 119 cited references, with 50 published articles and 11 documents identified as a primary framework reference. The average citations per year for the 61 frameworks reviewed ranged from 0.7 to 103.3 among articles published from 1985 to 2012. Citation rates from all frameworks are reported with citation network analyses for the framework review article and ten highly cited framework seed articles. The main path for the D&I framework citation network is presented.

CONCLUSIONS

We examined citation rates and the main paths through the citation network to delineate the current landscape of D&I framework research, and opportunities for advancing framework development and use. Dissemination and implementation researchers and practitioners may consider frequency of framework citation and our network findings when planning implementation efforts to build upon this foundation and promote systematic advances in D&I science.

Mixed methods analysis of eighteen worksite policies, programs, and environments for physical activity

Background

This study examined whether specific worksite supports for physical activity (PA) were associated with total and domain-specific PA.

Methods

A cross-sectional, telephone-based study was conducted in four Missouri, USA, metropolitan areas in 2012 and 2013. Outcome variables included total PA and sub-domains (leisure, work, travel) measured using the International Physical Activity Questionnaire. Logistic regression determined odds of meeting PA recommendations, given access to and use of 18 unique PA worksite supports. A subsample of 119 participants also wore hip accelerometry for seven consecutive days and maintained a wear-time diary. Access to worksite supports were associated with odds of meeting objective moderate and vigorous (MV) PA above 150 min per week.

Results

Among 2013 survey participants, meeting PA recommendations while performing work-related tasks was significantly associated with several supports (e.g., walking maps, stair prompts), as was meeting recommendations during travel (e.g., flextime for PA, incentives for public transportation, walking/bicycling to work). Access to 11 worksite supports increased odds of meeting PA recommendations through leisure-time PA; five supports were associated with total PA. There were significant differences between access to and use of supports. Using objective MVPA, access to worksite challenges and bike storage were significantly associated with five and three times greater odds of meeting 150 min of MVPA per week, respectively.

Conclusions

Worksite wellness plans are increasing across the US and employers are eager for evidence-based supports for increasing PA. This study provides insights into the utility of multiple worksite supports for PA to increase odds that employees meet PA recommendations.

Work-related correlates of occupational sitting in a diverse sample of employees in Midwest metropolitan cities

The worksite serves as an ideal setting to reduce sedentary time. Yet little research has focused on occupational sitting, and few have considered factors beyond the personal or socio-demographic level. The current study i) examined variation in occupational sitting across different occupations, ii) explored whether worksite level factors (e.g., employer size, worksite supports and policies) may be associated with occupational sitting. Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone and provided information on socio-demographic characteristics, schedule flexibility, occupation, work related factors, and worksite supports and policies. Occupational sitting was self-reported (daily minutes spent sitting at work), and dichotomized. Occupation-stratified analyses were conducted to identify correlates of occupational sitting using multiple logistic regressions. A total of 1668 participants provided completed data. Those employed in business and office/administrative support spent more daily occupational sitting time (median 330 min) compared to service and blue collar employees (median 30 min). Few worksite supports and policies were sitting specific, yet factors such as having a full-time job, larger employer size, schedule flexibility, and stair prompt signage were associated with occupational sitting. For example, larger employer size was associated with higher occupational sitting in health care, education/professional, and service occupations. Work-related factors, worksite supports and policies are associated with occupational sitting. The pattern of association varies among different occupation groups. This exploratory work adds to the body of research on worksite level correlates of occupational sitting. This may provide information on priority venues for targeting highly sedentary occupation groups.

An Overview of Research and Evaluation Designs for Dissemination and Implementation

The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs. This article is one product of a design workgroup that was formed in 2013 by the National Institutes of Health to address dissemination and implementation research, and whose members represented diverse methodologic backgrounds, content focus areas, and health sectors. These experts integrated their collective knowledge on dissemination and implementation designs with searches of published evaluations strategies. This article emphasizes randomized and nonrandomized designs for the traditional translational research continuum or pipeline, which builds on existing efficacy and effectiveness trials to examine how one or more evidence-based clinical/prevention interventions are adopted, scaled up, and sustained in community or service delivery systems. We also mention other designs, including hybrid designs that combine effectiveness and implementation research, quality improvement designs for local knowledge, and designs that use simulation modeling.

Dissemination and Implementation Science Training Needs: Insights From Practitioners and Researchers

INTRODUCTION

Dissemination and implementation research training has great potential to improve the impact and reach of health-related research; however, research training needs from the end user perspective are unknown. This paper identifies and prioritizes dissemination and implementation research training needs.

METHODS

A diverse sample of researchers, practitioners, and policymakers was invited to participate in Concept Mapping in 2014-2015. Phase 1 (Brainstorming) gathered participants' responses to the prompt: To improve the impact of research evidence in practice and policy settings, a skill in which researchers need more training is… The resulting statement list was edited and included subsequent phases. Phase 2 (Sorting) asked participants to sort each statement into conceptual piles. In Phase 3 (Rating), participants rated the difficulty and importance of incorporating each statement into a training curriculum. A multidisciplinary team synthesized and interpreted the results in 2015-2016.

RESULTS

During Brainstorming, 60 researchers and 60 practitioners/policymakers contributed 274 unique statements. Twenty-nine researchers and 16 practitioners completed sorting and rating. Nine concept clusters were identified: Communicating Research Findings, Improve Practice Partnerships, Make Research More Relevant, Strengthen Communication Skills, Develop Research Methods and Measures, Consider and Enhance Fit, Build Capacity for Research, and Understand Multilevel Context. Though researchers and practitioners had high agreement about importance (r =0.93) and difficulty (r =0.80), ratings differed for several clusters (e.g., Build Capacity for Research).

CONCLUSIONS

Including researcher and practitioner perspectives in competency development for dissemination and implementation research identifies skills and capacities needed to conduct and communicate contextualized, meaningful, and relevant research.

Comparison of Research Framing Preferences and Information Use of State Legislators and Advocates Involved in Cancer Control, United States, 2012-2013

Introduction

Evidence-based policy plays an important role in prevention of cancer and other chronic diseases. The needs of actors involved in policy decision-making should inform knowledge translation strategies. This study examines the differences between state legislators and advocates in how they seek and use information and what their preferences are for how research information is framed.

Methods

We conducted a cross-sectional comparison of survey responses by US advocates (n = 77) and state legislators (n = 265) working on issues related to cancer control.

Results

Advocates differed significantly from legislators on all demographic characteristics. Advocates reported seeking and using information more frequently than legislators, though legislators used legislative research bureaus more often (0.45 point difference, P = .004). Both legislators and advocates prioritized the presentation and timeliness of research information similarly but reported different preferences for source (information bias, information relevance, delivery of information by trusted person) of research information. Several differences between advocates and legislators were modified by participant age.

Conclusion

Our study provides insights for development of knowledge translation strategies to enhance evidence-based policy making for cancer control that are tailored to state-level legislators and advocates. Additional research efforts should evaluate the effectiveness of such knowledge translation strategies, particularly among advocates.

Development of a Comprehensive Assessment of Food Parenting Practices: The Home Self-Administered Tool for Environmental Assessment of Activity and Diet Family Food Practices Survey

BACKGROUND

Parents' food parenting practices influence children's dietary intake and risk for obesity and chronic disease. Understanding the influence and interactions between parents' practices and children's behavior is limited by a lack of development and psychometric testing and/or limited scope of current measures. The Home Self-Administered Tool for Environmental Assessment of Activity and Diet (HomeSTEAD) was created to address this gap.

OBJECTIVE

This article describes development and psychometric testing of the HomeSTEAD family food practices survey.

PARTICIPANTS/DESIGN

Between August 2010 and May 2011, a convenience sample of 129 parents of children aged 3 to 12 years were recruited from central North Carolina and completed the self-administered HomeSTEAD survey on three occasions during a 12- to 18-day window. Demographic characteristics and child diet were assessed at Time 1. Child height and weight were measured during the in-home observations (following Time 1 survey).

STATISTICAL ANALYSIS

Exploratory factor analysis with Time 1 data was used to identify potential scales. Scales with more than three items were examined for scale reduction. Following this, mean scores were calculated at each time point. Construct validity was assessed by examining Spearman rank correlations between mean scores (Time 1) and children's diet (fruits and vegetables, sugar-sweetened beverages, snacks, sweets) and body mass index (BMI) z scores. Repeated measures analysis of variance was used to examine differences in mean scores between time points, and single-measure intraclass correlations were calculated to examine test-retest reliability between time points.

RESULTS

Exploratory factor analysis identified 24 factors and retained 124 items; however, scale reduction narrowed items to 86. The final instrument captures five coercive control practices (16 items), seven autonomy support practices (24 items), and 12 structure practices (46 items). All scales demonstrated good internal reliability (α>.62), 18 factors demonstrated construct validity (significant association with child diet, P<0.05), and 22 demonstrated good reliability (intraclass correlation coefficient>0.61).

CONCLUSIONS

The HomeSTEAD family food practices survey provides a brief, yet comprehensive and psychometrically sound assessment of food parenting practices.

The role of researchers in disseminating evidence to public health practice settings: a cross-sectional study

BACKGROUND

Evidence-based public health interventions, which research has demonstrated offer the most promise for improving the population's health, are not always utilized in practice settings. The extent to which dissemination from researchers to public health practice settings occurs is not widely understood. This study examines the extent to which public health researchers in the United States are disseminating their research findings to local and state public health departments.

METHODS

In a 2012, nationwide study, an online questionnaire was administered to 266 researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, and universities to determine dissemination practices. Logistic regression analyses were used to examine the association between dissemination to state and/or local health departments and respondent characteristics, facilitators, and barriers to dissemination.

RESULTS

Slightly over half of the respondents (58%) disseminated their findings to local and/or state health departments. After adjusting for other respondent characteristics, respondents were more likely to disseminate their findings to health departments if they worked for a university Prevention Research Center or the Centers for Disease Control and Prevention, or received their degree more than 20 years ago. Those who had ever worked in a practice or policy setting, those who thought dissemination was important to their own research and/or to the work of their unit/department, and those who had expectations set by their employers and/or funding agencies were more likely to disseminate after adjusting for work place, graduate degree and/or fellowship in public health, and the year the highest academic degree was received.

CONCLUSIONS

There is still room for improvement in strengthening dissemination ties between researchers and public health practice settings, and decreasing the barriers researchers face during the dissemination process. Researchers could better utilize national programs or workshops, knowledge brokers, or opportunities provided through academic institutions to become more proficient in dissemination practices.

Worksite nutrition supports and sugar-sweetened beverage consumption

Objective

This study examined the link between worksite environmental supports for nutrition behaviours and sugar‐sweetened beverage (SSB) consumption and offers insight into potential intervention points for reducing SSB consumption and combatting overweight and obesity.

Methods

Perceived worksite supports for healthy nutrition and self‐reported SSB consumption were analysed for 2,015 working adults in the state of Missouri using a subset of questions from the Supports at Home and Work for Maintaining Energy Balance (SHOW‐ME) study.

Results

Employees' use of vending facilities and the availability of water coolers/water bottles was significantly associated with increased SSB consumption, while use of cafeterias was significantly associated with decreased SSB consumption. Symbols or signs to identify healthy alternatives were significantly associated with sports drink consumption.

Conclusions

This study supports previous work indicating the worksite as a necessary environment for nutrition interventions. When choices (vending and cafeteria) are provided, employees report making healthier decisions. For worksites without cafeterias, alternatives should be explored including mobile food trucks and farmer's markets.

Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review

PURPOSE

The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes.

METHODS

Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component.

RESULTS

There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted.

CONCLUSIONS

The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.

Comparison of Adherence to Guideline-Based Cholesterol Treatment Goals in Men Versus Women

Studies show women do not receive aggressive cardiovascular interventions and may not be given guideline-based treatment to reduce cardiac events. We describe cholesterol treatment in an academic practice of family and internal medicine physicians to understand factors associated with achievement of guideline-based treatment goals in women compared with men. Primary care patients aged 40 to 75 years were included if they were prescribed a statin, had a Framingham risk score of ≥ 10%, had diabetes, or had atherosclerotic cardiovascular disease. Patients were classified into Adult Treatment Panel III categories and assessed to whether they were in compliance with Adult Treatment Panel III guidelines. Odds ratios of goal adherence between women and men were calculated, and a multivariate model for goal achievement was created. In 2,747 patients, women were less likely to achieve cholesterol goals (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.70 to 0.95) despite having more prescriptions for statins (48% vs 39%, p <0.001). More women than men failed to reach low-density lipoprotein goals because they were not prescribed a statin (OR 0.69; 95% CI 0.56 to 0.85) and women on high-intensity statins were less likely than men to achieve goals (OR 0.51; 95% CI 0.27 to 0.96). In all patients, diabetes was associated with nonattainment of cholesterol goals, but in high-risk women, the presence of diabetes improved goal achievement. In conclusion, women achieved guideline-based cholesterol recommendations at a lower rate than men, even when individual goals are considered.

Which worksite supports for healthy weight do employees use?

This paper explores factors associated with employee use of available supports for improving nutrition and activity behaviors. A cross-sectional telephone-survey assessed presence and use of available program, facility, and policy supports. Logistic regression was used to explore associations between job characteristics (e.g., supervising others) and use of available supports, adjusting for demographic characteristics. After adjustment, most supports were associated with at least one job-related factor. Participants supervising others were more likely to utilize eight supports including personal services for fitness, indoor exercise and shower facilities, and flextime for physical activity. The programs and facilities associated with the most factors were health fairs (e.g., increased likelihood with increased hours worked/week) and indoor exercise and shower facilities (e.g., increased likelihood with increased flexibility at work), respectively. Policies were associated with fewer factors. Since use of many programs and facilities differed based on job-related factors, employers might target supports based on job-related factors.