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Dodson EA, Parks RG, Jacob RR, An R, Eyler AA, Lee N, Morshed AB, Politi MC, Tabak RG, Yan Y, Brownson RC. Effectively communicating with local policymakers: a randomized trial of policy brief dissemination to address obesity. Front Public Health 2024; 12:1246897. [PMID: 38525334 PMCID: PMC10957535 DOI: 10.3389/fpubh.2024.1246897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/05/2024] [Indexed: 03/26/2024] Open
Abstract
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.
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Affiliation(s)
- Elizabeth A. Dodson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Renee G. Parks
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Rebekah R. Jacob
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ruopeng An
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Amy A. Eyler
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | | | - Alexandra B. Morshed
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mary C. Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Rachel G. Tabak
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, United States
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Parks RG, Thomas F, Morshed AB, Dodson EA, Tian R, Politi MC, Eyler AA, Thomas I, Brownson RC. Municipal officials' perspectives on policymaking for addressing obesity and health equity. Evid Policy 2023; 19:444-464. [PMID: 38650970 PMCID: PMC11034731 DOI: 10.1332/174426421x16793276974116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background Obesity evidence-based policies (EBPs) can make a lasting, positive impact on community health; however, policy development and enactment is complex and dependent on multiple forces. Aims and objectives This study investigated key factors affecting municipal officials' policymaking for obesity and related health disparities. Methods Semi-structured interviews were conducted with 20 local officials from a selection of municipalities with high obesity or related health disparities across the United States between December 2020 and April 2021. Findings Policymakers follow a general decision-making process with limited distinction between health and other policy areas. Factors affecting policymaking included: being informed about other local, state, and federal policy, conducting their own research using trustworthy sources, and seeking constituent and stakeholder perspectives. Key facilitators included the need for timely, relevant local data, and seeing or hearing from those impacted. Key local policymaking barriers included constituent opposition, misinformation, controversial issues with contentious solutions, and limited understanding of the connection between issues and obesity/health. Policymakers had a range of understanding about causes of health disparities, including views of individual choices, environmental influences on behaviors, and structural factors impacting health. To address health disparities, municipal officials described: a variety of roles policymakers can take, limitations based on the scope of government, challenges with intergovernmental collaboration or across government levels, ability of policymakers and government employees to understand the problem, and the challenge of framing health disparities given the social-political context. Discussion and conclusion Understanding factors affecting the uptake of EBPs can inform local-level interventions that encourage EBP adoption.
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Affiliation(s)
- Renee G. Parks
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Fanice Thomas
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Alexandra B. Morshed
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Elizabeth A. Dodson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Ruiyi Tian
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | - Mary C. Politi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Amy A. Eyler
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
| | | | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
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Baumann AA, Hooley C, Kryzer E, Morshed AB, Gutner CA, Malone S, Walsh-Bailey C, Pilar M, Sandler B, Tabak RG, Mazzucca S. A scoping review of frameworks in empirical studies and a review of dissemination frameworks. Implement Sci 2022; 17:53. [PMID: 35945548 PMCID: PMC9361268 DOI: 10.1186/s13012-022-01225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, USA.
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, USA
| | - Emily Kryzer
- BJC HealthCare, Community Health Improvement, St. Louis, USA
| | | | - Cassidy A Gutner
- ViiV Healthcare, Research Triangle Park, NC, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Sara Malone
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Callie Walsh-Bailey
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Brittney Sandler
- Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Rachel G Tabak
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
| | - Stephanie Mazzucca
- Brown School of Social Work, Washington University in St. Louis, St. Louis, USA
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Walsh-Bailey C, Tsai E, Tabak RG, Morshed AB, Norton WE, McKay VR, Brownson RC, Gifford S. A scoping review of de-implementation frameworks and models. Implement Sci 2021; 16:100. [PMID: 34819122 PMCID: PMC8611904 DOI: 10.1186/s13012-021-01173-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Edward Tsai
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, USA
| | - Rachel G Tabak
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Alexandra B Morshed
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Wynne E Norton
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20850, USA
| | - Virginia R McKay
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, 4921 Parkview Place, Saint Louis, MO, 63110, USA
| | - Sheyna Gifford
- Department of Physical Medicine and Rehabilitation, Washington University in St. Louis, 4444 Forest Park Ave, Campus Box 8518, St. Louis, MO, 63108, USA
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Haire-Joshu D, Morshed AB, Phad A, Johnston S, Tabak RG. Applying RE-AIM to Evaluate the External Validity of Weight Gain Prevention Interventions in Young Adults: A Systematic Review. J Public Health Manag Pract 2021; 27:154-165. [PMID: 32332487 PMCID: PMC7837750 DOI: 10.1097/phh.0000000000001159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Debra Haire-Joshu
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Alexandra B. Morshed
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Allison Phad
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Shelly Johnston
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
| | - Rachel G. Tabak
- Center for Diabetes Translation Research (Drs Haire-Joshu and Tabak and Mss Phad and Johnston), Center for Obesity Prevention and Policy Research (Dr Haire-Joshu), and Prevention Research Center (Drs Morshed and Tabak), the Brown School, Washington University in St Louis, St Louis, Missouri
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Anthony H, Tabak R, Morshed AB, Schwarz C, Phad A, Haire-Joshu D. Awareness and accuracy of height and weight among mothers and their preschool-aged children. Public Health 2020; 182:151-154. [PMID: 32320905 PMCID: PMC7265393 DOI: 10.1016/j.puhe.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/18/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A constant challenge in addressing the issue of obesity is the validity and reliability of self-reported measurements to calculate body mass index, that assesses the prevalence of obesity in a population. The objective of this study is to analyze both awareness and accuracy of mothers who are overweight or obese, in reporting their own and their child's height and weight measurements. STUDY DESIGN cross-sectional study. METHODS In this study, mothers were asked over phone to self-report height and weight for them and their child. This was followed by objective measurement of maternal and child height and weight by study staff in a clinical setting. The descriptive and statistical analysis of the data obtained were carried out using SAS software. RESULTS 1) The mean weight of mothers who inaccurately self-reported their weight was 9.5 kg greater than the mean weight of those who reported accurately (P < 0.001). (2) Despite being aware of, and reporting their own measurements, 50% (n = 116) of mothers reported not knowing their child's height and 23% (n = 54) of them reported not knowing their child's weight. CONCLUSION Strategies to tackle both maternal awareness and accuracy of child's measurements can help with early identification of child's obesity risk and prevention of long-term consequences.
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Affiliation(s)
- H Anthony
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA; Department of Gastroenterology, Internal Medicine, Washington University in St. Louis, USA.
| | - R Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - A B Morshed
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - C Schwarz
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - A Phad
- Center for Diabetes Translation and Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63110, USA
| | - D Haire-Joshu
- Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA; Department of Internal Medicine, Washington University School of Medicine, Washington University in St. Louis, USA
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Tabak RG, Morshed AB, Schwarz CD, Haire‐Joshu D. Weight gain prevention content delivered to mothers: Lessons from an intervention embedded in a community organization. Obes Sci Pract 2019; 5:540-547. [PMID: 31890244 PMCID: PMC6934432 DOI: 10.1002/osp4.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Rachel G. Tabak
- The Brown SchoolWashington University in St. LouisSt. LouisMissouri
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Morshed AB, Kasman M, Heuberger B, Hammond RA, Hovmand PS. A systematic review of system dynamics and agent-based obesity models: Evaluating obesity as part of the global syndemic. Obes Rev 2019; 20 Suppl 2:161-178. [PMID: 31317637 DOI: 10.1111/obr.12877] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 11/28/2022]
Abstract
The problem of obesity has recently been reframed as part of the global syndemic-the co-occurring, interacting pandemics of obesity, undernutrition, and climate change that are driven by common underlying societal drivers. System science modeling approaches may help clarify how these shared drivers operate and the best ways to address them. The objective of this paper was to determine to what extent existing agent-based and system dynamics computational models of obesity provide insights into the shared drivers of the global syndemic. Peer-reviewed studies published until July 2018 were identified from Scopus, Web of Science, and PubMed databases. Thirty-eight studies representing 30 computational models were included. They show a growing use of system dynamics and agent-based modeling in the past decade. They most often examined mechanisms and interventions in the areas of social network-based influences on obesity, physiology and disease state mechanics, and the role of food and physical activity environments. Usefulness for identifying common drivers of the global syndemic was mixed; most models represented Western settings and focused on obesity determinants close to the person (eg, social circles, school settings, and neighborhood environments), with a relative paucity in models at mesolevel and macrolevel and in developing country contexts.
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Affiliation(s)
| | | | | | - Ross A Hammond
- Brown School, Washington University in St. Louis, St. Louis, Missouri.,The Brookings Institution, Washington, DC.,The Santa Fe Institute, Santa Fe, New Mexico
| | - Peter S Hovmand
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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Morshed AB, Tabak RG, Schwarz CD, Haire-Joshu D. The Impact of a Healthy Weight Intervention Embedded in a Home-Visiting Program on Children's Weight and Mothers' Feeding Practices. J Nutr Educ Behav 2019; 51:237-244. [PMID: 30385250 PMCID: PMC6392451 DOI: 10.1016/j.jneb.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/24/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
| | - Rachel G Tabak
- Brown School, Washington University in St Louis, St Louis, MO
| | | | - Debra Haire-Joshu
- Brown School, Washington University in St Louis, St Louis, MO; Department of Medicine, Washington University School of Medicine, Washington University in St Louis, St Louis, MO
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McKay VR, Morshed AB, Brownson RC, Proctor EK, Prusaczyk B. Letting Go: Conceptualizing Intervention De-implementation in Public Health and Social Service Settings. Am J Community Psychol 2018; 62:189-202. [PMID: 29971792 PMCID: PMC6175194 DOI: 10.1002/ajcp.12258] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The discontinuation of interventions that should be stopped, or de-implementation, has emerged as a novel line of inquiry within dissemination and implementation science. As this area grows in human services research, like public health and social work, theory is needed to help guide scientific endeavors. Given the infancy of de-implementation, this conceptual narrative provides a definition and criteria for determining if an intervention should be de-implemented. We identify three criteria for identifying interventions appropriate for de-implementation: (a) interventions that are not effective or harmful, (b) interventions that are not the most effective or efficient to provide, and (c) interventions that are no longer necessary. Detailed, well-documented examples illustrate each of the criteria. We describe de-implementation frameworks, but also demonstrate how other existing implementation frameworks might be applied to de-implementation research as a supplement. Finally, we conclude with a discussion of de-implementation in the context of other stages of implementation, like sustainability and adoption; next steps for de-implementation research, especially identifying interventions appropriate for de-implementation in a systematic manner; and highlight special ethical considerations to advance the field of de-implementation research.
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Affiliation(s)
- Virginia R. McKay
- Center for Public Health Systems ScienceBrown SchoolWashington University in St. LouisSt. LouisMOUSA
- Institute of Clinical and Translational ScienceWashington University School of Medicine in St. LouisSt. LouisMOUSA
| | - Alexandra B. Morshed
- Prevention Research Center in St. LouisBrown SchoolWashington University in St. LouisSt. LouisMOUSA
| | - Ross C. Brownson
- Prevention Research Center in St. LouisBrown SchoolWashington University in St. LouisSt. LouisMOUSA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer CenterWashington University School of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Enola K. Proctor
- Institute of Clinical and Translational ScienceWashington University School of Medicine in St. LouisSt. LouisMOUSA
- Center for Mental Health Services ResearchGeorge Warren Brown School of Social WorkWashington University in St. LouisSt. LouisMOUSA
- Institute for Public HealthWashington University in St. LouisSt. LouisMOUSA
| | - Beth Prusaczyk
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Center for Clinical Quality and Implementation ResearchVanderbilt University Medical CenterNashvilleTNUSA
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11
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Tabak RG, Morshed AB, Schwarz CD, Haire-Joshu D. Impact of a Healthy Weight Intervention Embedded Within a National Home Visiting Program on the Home Food Environment. Front Public Health 2018; 6:178. [PMID: 29998092 PMCID: PMC6028746 DOI: 10.3389/fpubh.2018.00178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/31/2018] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Rachel G Tabak
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States.,The Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Alexandra B Morshed
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States.,The Prevention Research Center, Washington University in St. Louis, St. Louis, MO, United States
| | - Cynthia D Schwarz
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Debra Haire-Joshu
- The Brown School, Washington University in St. Louis, St. Louis, MO, United States
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12
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Morshed AB, Ballew P, Elliott MB, Haire-Joshu D, Kreuter MW, Brownson RC. Evaluation of an online training for improving self-reported evidence-based decision-making skills in cancer control among public health professionals. Public Health 2017; 152:28-35. [PMID: 28732323 PMCID: PMC5966825 DOI: 10.1016/j.puhe.2017.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this evaluation was to assess the effect of the online evidence-based cancer control (EBCC) training on improving the self-reported evidence-based decision-making (EBDM) skills in cancer control among Nebraska public health professionals. STUDY DESIGN Cross-sectional group comparison. METHODS Previously developed EBDM measures were administered via online surveys to 201 public health professionals at baseline (comparison group) and 123 professionals who took part in the training. Respondents rated the importance of and their skill level in 18 EBCC skills. Differences were examined using analysis of variance models adjusted for gender, age, years at agency, and years in position, and stratified by respondent educational attainment. RESULTS Among professionals without an advanced degree, training participants reported higher overall skill scores (P = .016) than the baseline non-participant group, primarily driven by differences in the partnerships and collaboration and evaluation domains. No differences in importance ratings were observed. Among professionals with advanced degrees, there were no differences in skill scores and small differences in importance scores in the expected direction (P < .05). Respondents at baseline rated the following facilitators for EBDM as important: expectations from agency leaders and community partners, high priority placed on EBDM by leadership, trainings, and positive feedback. They also reported using a variety of materials for making decisions about programs and policies, though few used individual scientific studies. CONCLUSIONS EBCC led to improved self-reported EBDM skills among public health professionals without an advanced degree, though a gap remained between the self-reported skills and the perceived importance of the skills. Further research on training content and modalities for professionals with higher educational attainment and baseline skill scores is needed.
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Affiliation(s)
- A B Morshed
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - P Ballew
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - M B Elliott
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - D Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - M W Kreuter
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - R C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA; Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
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13
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Morshed AB, Dodson EA, Tabak RG, Brownson RC. Comparison of Research Framing Preferences and Information Use of State Legislators and Advocates Involved in Cancer Control, United States, 2012-2013. Prev Chronic Dis 2017; 14:E10. [PMID: 28152363 PMCID: PMC5303654 DOI: 10.5888/pcd14.160292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Alexandra B Morshed
- Washington University in St. Louis, Campus Box 1196, One Brookings Dr, St. Louis, MO 63130.
| | - Elizabeth A Dodson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Rachel G Tabak
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, Missouri.,Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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14
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Davis SM, Myers OB, Cruz TH, Morshed AB, Canaca GF, Keane PC, O'Donald ER. CHILE: Outcomes of a group randomized controlled trial of an intervention to prevent obesity in preschool Hispanic and American Indian children. Prev Med 2016; 89:162-168. [PMID: 27222162 PMCID: PMC4969221 DOI: 10.1016/j.ypmed.2016.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/01/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We examined the outcomes of the Child Health Initiative for Lifelong Eating and Exercise (CHILE) study, a group randomized controlled trial to design, implement, and test the efficacy of a trans-community intervention to prevent obesity in children enrolled in Head Start centers in rural American Indian and Hispanic communities in New Mexico. METHODS CHILE was a 5-year evidence-based intervention that used a socioecological approach to improving dietary intake and increasing physical activity of 1898 children. The intervention included a classroom curriculum, teacher and food service training, family engagement, grocery store participation, and healthcare provider support. Height and weight measurements were obtained four times (fall of 2008, spring and fall of 2009, and spring of 2010), and body mass index (BMI) z-scores in the intervention and comparison groups were compared. RESULTS At baseline, demographic characteristics in the comparison and intervention groups were similar, and 33% of all the children assessed were obese or overweight. At the end of the intervention, there was no significant difference between the two groups in BMI z-scores. CONCLUSIONS Obesity prevention research among Hispanic and AI preschool children in rural communities is challenging and complex. Although the CHILE intervention was implemented successfully, changes in overweight and obesity may take longer than 2years to achieve.
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Affiliation(s)
- Sally M Davis
- Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States.
| | - Orrin B Myers
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Theresa H Cruz
- Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Alexandra B Morshed
- Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Glenda F Canaca
- Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Patricia C Keane
- Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Elena R O'Donald
- Prevention Research Center, Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
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Morshed AB, Davis SM, Keane PC, Myers OB, Mishra SI. The Impact of the CHILE Intervention on the Food Served in Head Start Centers in Rural New Mexico. J Sch Health 2016; 86:414-23. [PMID: 27122141 PMCID: PMC4852386 DOI: 10.1111/josh.12393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 10/02/2015] [Accepted: 01/09/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Child Health Initiative for Lifelong Eating and Exercise is a multicomponent obesity-prevention intervention, which was evaluated among Head Start (HS) centers in American Indian and predominantly Hispanic communities in rural New Mexico. This study examines the intervention's foodservice outcomes: fruits, vegetables, whole grains, discretionary fats, added sugars, and fat from milk served in meals and snacks. METHODS Sixteen HS centers were randomized to intervention/comparison groups, following stratification by ethnicity and preintervention median body mass index of enrolled children. The foodservice component included quarterly trainings for foodservice staff about food purchasing and preparation. Foods served were evaluated before and after the 2-year intervention, in the fall 2008 and spring 2010. RESULTS The intervention significantly decreased fat provided through milk and had no significant effect on fruit, vegetables and whole-grain servings, discretionary fats, and added sugar served in HS meals and snacks. When effect modification by site ethnicity was examined, the effect on fat provided through milk was only found in American Indian sites. CONCLUSIONS Foodservice interventions can reduce the amount of fat provided through milk served in HS. More research is needed regarding the implementation of foodservice interventions to improve the composition of foods served in early education settings.
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Affiliation(s)
- Alexandra B Morshed
- Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899.
| | - Sally M Davis
- Department of Pediatrics, Director, Prevention Research Center, University of New Mexico, MSC 11 6145, Albuquerque, NM 87131.
| | - Patricia C Keane
- Department of Pediatrics, University of New Mexico Prevention Research Center, MSC 11 6145, Albuquerque, NM 87131.
| | - Orrin B Myers
- Department of Internal Medicine, University of New Mexico, MSC 10 5550, Albuquerque, NM 87131.
| | - Shiraz I Mishra
- Department of Pediatrics, University of New Mexico, Albuquerque, NM 87131.
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