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A systematic review of children's dietary interventions with parents as change agents: Application of the RE-AIM framework
Abstract and Figures
Introduction:
Interventions targeting children's dietary behavior often include strategies that target parents as implementation agents of change, though parent involvement on intervention effectiveness is unclear. The present study systematically assessed (1) reporting of reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of child dietary intervention studies with parents as change agents and (2) evaluated within these studies the comparative effectiveness of interventions with and without a parent component.
Methods:
The search was conducted in PubMed, PsychINFO, and Cochrane Library. Eligible studies were required to include a condition with a parental component, a comparison/control group, and target a child dietary behavior outcome. Forty-nine articles met criteria. Raters extracted RE-AIM and parent implementation information for each study.
Results:
Effectiveness (72.5%) was the highest reported RE-AIM element, followed by reach (27.5%), adoption (12.5%), implementation (10%), and maintenance (2.5%). Median reporting of parent implementation was highest for adoption and enactment (20%), followed by receipt (7.5%), and maintenance (2.5%). Six studies tested comparative effectiveness of parental involvement on child dietary outcomes.
Conclusion:
Current RE-AIM reporting among children's dietary interventions is inchoate. The contribution of parental involvement on intervention effectiveness remains unclear. Increased focus should be placed on reporting of external validity information, to enable better translation of research to practical applications.
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... A well-designed intervention can help parents to create changes in the home environment [18]. However, reaching parents is challenging [19]. ...
... Schools and childcare organizations reach many children through their existing infrastructure [20], and thus are potential pathways for reaching both children and their parents. In addition, school or childcare EBRB interventions with parental involvement have been increasingly investigated [18,[21][22][23][24], as settings do not operate in isolation but interact with other settings and intermediates [25]. In other words, the influence a parent has on a child's behavior is affected by the way childcare staff handle similar situations, and vice versa [26,27]. ...
... However, this more intensive form of parental involvement might result in compromises regarding reach and adoption, as fewer parents might participate. Furthermore, it remains unclear whether direct strategies are more effective in creating intervention enactment among parents [18]. Simply implementing any form of direct (or active) parental involvement is therefore not the solution. ...
Parental involvement is an essential component of obesity prevention interventions for children. The present study provides a process and impact evaluation of the family component of SuperFIT. SuperFIT is a comprehensive, integrated intervention approach aiming to improve energy balance-related behaviors (EBRBs) of young children (2–4 years). A mixed methods design combined in-depth interviews with parents (n = 15) and implementers (n = 3) with questionnaire data on nutritional and physical activity-related parenting practices (CFPQ and PPAPP), the physical home environment (EPAO_SR) (n = 41), and intervention appreciation (n = 19). Results were structured using the concepts of reach, adoption, implementation, and perceived impact. Findings indicated that the families reached were mostly those that were already interested in the topic. Participants of the intervention appreciated the information received and the on-the-spot guidance on their child’s behavior. Having fun was considered a success factor within the intervention. Parents expressed the additional need for peer-to-peer discussion. SuperFIT increased awareness and understanding of parents’ own behavior. Parents made no changes in daily life routines or the physical home environment. Translating knowledge and learned strategies into behavior at home has yet to be achieved. To optimize impact, intervention developers should find the right balance between accessibility, content, and intensity of interventions for parents.
... The RE-AIM framework has been used recently in several systematic reviews to evaluate the internal and external validities of health intervention studies such as weight management intervention [18], physical activity intervention [22,23], worksite health behavior interventions [24], community settings [20], school-based health promotion [25,26], childhood obesity prevention [27][28][29], children dietary interventions with parents [30], injury prevention strategies [31], faith-based intervention [32], mobile phone-based intervention for diabetes self-management [33], and HIV prevention intervention [34]. While encouraging, there is little reporting on its potential use for translating HPV vaccination social media-driven intervention methods into regular practice settings, specifically at the population level. ...
... The reporting for the reach dimension indicators ranges from 77% to 100%. Many of the articles included in this review provided detailed descriptions of the target population which is consistent with the literature [25,[27][28][29][30]34,54,55]. Several articles targeted college students [37,38,43,44,48] which is not surprising given that the majority of those within the college-age groups are social media consumers. ...
... Tull et al.'s [49] study reported the highest vaccination rates (motivational arm 88%, self-regulatory arm 89%, and control arm 86%). Our systematic review showed that four indicators in the Efficacy/Effectiveness dimension including design/conditions, efficacy or effectiveness, the measure of the outcome with or without comparison to the vaccination goal, and short-term assessments, were regularly reported which is consistent with the literature [25,[27][28][29][30]34,54,55]. Across all 17 articles, less than half the authors described their chosen method of analysis for missing variables and/or attrition whether to use intent-to-treat or per-protocol analysis (analysis by treatment administered) approach. ...
Social media human papillomavirus (HPV) vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice is the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Seventeen articles published between 2006 and 2020 met the inclusion criteria. Three researchers independently coded each article using a validated RE-AIM framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, 3 were pilot efficacy studies, 10 were randomized controlled trials (RCTs) to evaluate effectiveness, 1 was a population-based study, and 3 did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.
... Most effective changes in the home setting are accomplished through interventions with direct parental involvement (e.g., parents attending educational sessions, or counselling sessions) [13,16,[19][20][21]. However, directly involving parents is often resource-and labour-intensive, making these types of interventions less feasible [20]. ...
... To involve more parents, and particularly those of vulnerable populations, the strategy of indirect parental involvement is an alternative. Even though indirect parental involvement is assumed to be less effective in changing health behaviours compared to direct parental involvement, it can lead to greater adoption and implementation rates [21]. In indirect parental involvement, parents are engaged in a way that the intervention implementers do not communicate or engage directly (i.e., face to face, or personally) with them. ...
... To our knowledge, there is little to no research on the participation rates of the strategy of the latter type of indirect parental involvement in school-based interventions, while this information is crucial to be able to draw conclusions on potential strategies to involve parents in (school-based) interventions [21]. Given the fact that children of vulnerable populations are less active, more sedentary and have unhealthier diets [31][32][33], it is possible that these children and their parents are less interested in energy balance-related interventions. ...
The Challenge Me intervention aimed to indirectly involve parents in a school-based intervention, by challenging primary school children to perform physical activity (PA) and nutrition-related activities with their parents. The aim of this study is to gain insight in whether this was a feasible strategy to engage children and parents, especially those of vulnerable populations. An exploratory cross-sectional study design was applied. Four primary schools implemented the intervention. Data consisted of challenges completed (intervention posters) and child and family characteristics (questionnaires and anthropometric measurements). Associations between challenges performed and child and family characteristics were assessed using linear regression analysis. Of the 226 study participants, 100% performed at least one challenge, and 93% performed at least one challenge involving parents. Children who performed more PA challenges were often younger, a sports club member, lived in higher socioeconomic status neighbourhoods, of Western ethnicity and from larger families. Regarding nutrition challenges involving parents, younger children performed more challenges. There was no difference in intervention engagement regarding gender, weight status, PA preference, healthy nutrition preference, or the Family PA and Family Nutrition Climate. Challenge Me has potential in involving parents in a school-based intervention. However, certain characteristics were associated with higher involvement.
... Specifically, the interventions in the review mainly focused on reporting intervention-specific components (e.g., sample size, intervention location, and effectiveness), with minimal reporting of broad or system-level components such as implementation costs, program-level sustainability, and intervention fidelity. Although concerning, the underreporting of broad or system-level elements is consistent with reports from other systematic reviews using the RE-AIM framework [110][111][112][113][114][115] that also found limited reporting of these dimensions. This further confirms the previous report on the predominant focus on intervention effectiveness, with limited attention to external factors that may impact the translation of effective interventions to realworld settings. ...
... Consistent with past reviews, intervention effectiveness was the most commonly reported RE-AIM element across all interventions, with baseline activity measures reported for all included interventions [110,111]. The outcome measures included; HIV incidence, number of For effectiveness analyses, only 5(20%) interventions reported using intent-to-treat analyses; this in turn may have impacted the positive effect of the intervention across the interventions. ...
... However, none of the interventions reported on the fidelity of the study, although it is a critical measure of the internal validity of the interventions. Therefore, it is unclear if the reported intervention impact were attributed to the fidelity of the intervention or to the actual intervention components [110]. Considering the critical role of these components in enhancing the impact and scale-up of such intervention, the scarcity of evidence in this area is a concern. ...
Background:
Economic empowerment (EE) HIV prevention programs for adolescent girls and young women (AGYW) in sub-Saharan Africa are gaining traction as effective strategies to reduce HIV risk and vulnerabilities among this population. While intervention effectiveness is critical, there are numerous factors beyond effectiveness that shape an intervention's impact. The objective of this systematic review was to assess the reporting of implementation outcomes of EE HIV prevention programs for AGYW in SSA, as conceptualized in the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework.
Methods:
We searched PubMed, Ovid/MEDLINE, Science Direct, Ebscohost, PsycINFO, Scopus, and Web of Science for EE HIV interventions for AGYW in SSA. Study selection and data extraction were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two researchers coded each article using a validated RE-AIM data extraction tool and independently extracted information from each article. The reporting of RE-AIM dimensions were summarized and synthesized across included interventions.
Results:
A total of 25 unique interventions (reported in 45 articles) met the predefined eligibility criteria. Efficacy/effectiveness 19(74.4%) was the highest reported RE-AIM dimension, followed by adoption 17(67.2%), reach 16(64.0%), implementation 9(38.0%), and maintenance 7(26.4%). Most interventions reported on RE-AIM components such as sample size 25(100.0%), intervention location 24(96.0%), and measures and results for at least one follow-up 24(96.0%). Few reported on RE-AIM components such as characteristics of non-participants 8(32.0%), implementation costs 3(12.0%), and intervention fidelity 0(0.0%).
Conclusions:
Results of the review emphasize the need for future economic empowerment HIV prevention interventions for AGYW in SSA to report multiple implementation strategies and highlight considerations for translating such programs into real-world settings. Researchers should pay close attention to reporting setting-level adoption, implementation cost, and intervention maintenance. These measures are needed for policy decisions related to the full merit and worth of EE HIV interventions and their long-term sustainability for AGYW.
... different parenting practices and ECEC teacher practices) within and between settings can negatively influence children's EBRBs (Bradley, 2010;Gubbels et al., 2018), highlighting the need for alignment across settings. Involving both ECEC teachers and parents has therefore been identified as crucial in previous evaluations of obesity prevention interventions in ECEC settings (Kader et al., 2015;Schlechter et al., 2016;Tomayko et al., 2021;van de Kolk et al., 2019). Although the involvement of parents and families in ECEC interventions is necessary to increase the effectiveness of interventions, questions remain about how to achieve optimal reach and adoption by parents Schlechter et al., 2016;van de Kolk, Verjans-Janssen, et al., 2019). ...
... Involving both ECEC teachers and parents has therefore been identified as crucial in previous evaluations of obesity prevention interventions in ECEC settings (Kader et al., 2015;Schlechter et al., 2016;Tomayko et al., 2021;van de Kolk et al., 2019). Although the involvement of parents and families in ECEC interventions is necessary to increase the effectiveness of interventions, questions remain about how to achieve optimal reach and adoption by parents Schlechter et al., 2016;van de Kolk, Verjans-Janssen, et al., 2019). ...
Interventions targeting nutrition and physical activity levels of pre-schoolers through early childhood education and care (ECEC) increasingly aim to involve families and the home setting. How to optimise the reach and adoption of interventions by parents remains an important question. This study aimed to assess the feasibility and acceptability of a take-home kit to promote nutrition and physical activity (PA) of pre-schoolers at home, while exploring the participatory approach of its development, implementation and evaluation. Three successive versions of the take-home kit were developed and distributed among 21 ECEC centres and 199 families in South-Limburg, the Netherlands. Acceptability and feasibility of the kit were monitored and acted upon throughout the research period. The take-home kit included a stuffed toy, PA and nutrition cards with simple activities, a journal in which parents were asked to record their activities, and written instructions. One kit per ECEC centre rotated between families. Thirty-seven parents participated in open-ended questionnaires, and ECEC teachers from six centres and five implementers participated in interviews. Both questionnaires and interviews included questions about the acceptability (i.e. content, design), feasibility and self-reported impact of the take-home kit. Parents appreciated the tangible and practical aspects of the materials. Using children’s play experience and clear instructions from ECEC teachers facilitated implementation at home. Both implementers and ECEC teachers needed room for contextualised solutions to barriers to implementing the take-home kit in practice. Based on the present study, we conclude that take-home kits can be a valuable tool for ECEC to reach and support parents in adopting healthy energy balance-related behaviours at home.
... Despite its importance, studies reporting organizational program maintenance (sustainability) in behavioral health interventions are rare [9] and are virtually absent in faith-based settings (see exception by [10]). Furthermore, systematic reviews of physical activity (PA) or healthy eating (HE) interventions that apply the RE-AIM framework conclude that reporting of maintenance is low overall [11][12][13][14][15][16][17]. ...
... This paper contributes to the literature by examining, within the context of a D&I study, change in organizational practices to promote PA and HE over two-years, predictors of organizational practices, and maintenance of these practices from immediately post-intervention (12 months) to one-year post-intervention (24 months). The paper fills several gaps in the translational and implementation science literatures including the lack of ecological interventions in this setting [18][19][20], the dearth of health behavior interventions that address organizational maintenance [9,[11][12][13][14][15][16][17], and the lack of studies that use constructs from the CFIR to predict implementation outcomes over time [32]. By using both RE-AIM and the CFIR to guide our project, we were able to not only consider factors important for assessing the public health impact of the program (RE-AIM), but also organizational and implementer characteristics (CFIR) that impact longer-term organizational practices. ...
Background:
Few studies have examined the impact of ecological health promotion interventions on organizational practices over time, especially in faith-based settings. This statewide dissemination and implementation study examined change in organizational practices and their predictors across a 24-month period, as well as maintenance of change.
Methods:
Using a pre-post quasi-experimental design, church coordinators from 92 United Methodist Churches in South Carolina (42% predominantly African American congregations) completed surveys at baseline, and immediate, 12-, and 24-months post-training regarding physical activity (PA) and healthy eating (HE) organizational practices consistent with the Faith, Activity, and Nutrition (FAN) program (opportunities, policies, pastor support, messages) and possible predictors. The study was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research (CFIR). Mixed model repeated measures analyses examined change in organizational practices over time. Regression models examined CFIR predictors of 24-month PA and HE organizational practices, controlling for baseline practices. Churches were also classified as maintainers (implemented at 12 and 24 months), non-sustained implementers (implemented at 12 but not 24 months), delayed implementers (implemented at 24 but not 12 months), and low implementers (implemented at neither 12 nor 24 months) for each FAN component.
Results:
PA and HE organizational practices increased over time (p < .0001). CFIR domains (and constructs within) of intervention characteristics (adaptability, relative advantage, cost/time), inner setting (relative priority, organizational rewards, readiness, congregant needs), characteristics of the implementer (self-efficacy, perceived benefits), and implementation process (engaging opinion leaders, engaging champions) were important predictors of 24-month PA and HE organizational practices. Over half of churches implementing PA policies, PA messages, HE policies, and HE opportunities at 12 months were maintainers at 24 months, and one-third were maintainers for PA opportunities, HE messages, and PA and HE pastor support. Furthermore, 16% of 12-month non-implementers were delayed implementers at 24 months for PA policies and 31% were delayed implementers for HE policies.
Conclusions:
This study makes important contributions to the faith-based health promotion literature by including a large sample of churches, testing an ecological intervention approach, and assessing organizational practices over a 24-month period. Study findings can guide technical assistance and program adaptations over time.
Trial registration:
This study was registered in clinicaltrials.gov NCT02868866 on August 16, 2016.
... RE-AIM is an acronym for the dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance, both at the individual-level and at the setting-level (More information can be found at www.re-aim.org). This framework has been widely used in studies seeking to understand real-world implementations, impacts, and the chance of generalization or replicability of the program to other groups and settings (Boersma, van Weert, Lakerveld, & Dröes, 2015;Cuthbert, King-Shier, Ruether, Tapp, & Culos-Reed, 2017;McGoey, Root, Bruner, & Law, 2015;Schlechter, Rosenkranz, Guagliano, & Dzewaltowski, 2016). Although specific RE-AIM dimensions may be used (Glasgow et al., 2019), comprehensive studies that include the five dimensions provide a holistic view of the topic of interest and help address "which complex intervention for what type of complex patients, delivered by what type of staff will be most costeffective, under which conditions and for what outcomes" (Gaglio, Shoup, & Glasgow, 2013, p. e45). ...
... Moreover, the scarcity of evidence about adoption and maintenance seems to be a challenge not only for SFP (10-14), but also for the field of health interventions in general. Systematic reviews have identified this same gap due to underdeveloped attention to such aspects in other health interventions (Boersma et al., 2015;Eakin, Bull, Glasgow, & Mason, 2002;O'Brien & Finch, 2014;Schlechter et al., 2016). ...
A scoping review, based on the RE-AIM framework, was conducted to analyze evidence of reach, effectiveness, adoption, implementation, and maintenance of the Strengthening Families Program (10-14), a preventive family-based substance abuse program for adolescents. Sixty-five articles were included. The results disclosed that effectiveness, implementation, and maintenance at the individual-level were the most evaluated aspects, while reach, maintenance at the setting-level, and adoption were the least investigated aspects. Positive effects on drug abuse prevention and protective parenting factors were found in the U.S. studies. Likewise, Latin American studies have shown the improvement of parenting practices. However, European studies have produced mixed results, with predominantly null effects on substance abuse. The implementation quality was high. There is no available evidence of adoption and maintenance at the setting-level by the organizations that implemented it. New studies must examine the reach, adoption, and sustainability of the program to lay foundations for its future use as an instrument of public policies.
... Parents determine what foods are offered to their children and provide an atmosphere in which children are eating (Galloway et al., 2006). Dietary habits established in youth have been shown to track throughout the lifespan (Craigie et al., 2011;Kelder et al., 1994), suggesting that youth dietary interventions should be pursued as a strategy to improve diet, and thereby combat obesity and decrease the risk of developing cancer, cardiovascular disease, and other chronic diseases (Schlechter et al., 2016). In a previous systematic review, Hingle et al. (2010) determined that parental involvement increased dietary intervention effectiveness and also determined which types of parent intervention strategies were most effective. ...
... It allows the researcher to focus on the extent to which the intervention attracts its targeted participants, the improvements or changes in the participants' lives, the setting/site/context of the intervention, its fidelity, transferability, and adaptability, as well as the intervention's evaluation and maintenance (Belza et al., 2006). Moreover, because parents serve as intervention agents (Faith et al., 2012), full reporting of the RE-AIM components can provide insight for the development of the types of parental interventions that are most likely to be adopted and implemented by parents (Schlechter et al., 2016). ...
Background
Current research shows that across the world people are eating poorly. This is leading to increased incidences of nutrition-related health problems.
Aim
This paper aims to provide a synthesis of research on the nutritional feeding programs and nutritional models used by primary caregivers in Africa, in order to identify best practice models, programs, and processes from the field of nutritional and feeding intervention development.
Methods
The research used a narrative review methodology. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used to disseminate results to allow for cross-comparison of core components inherent in health promotion interventions. We chose the RE-AIM framework as it facilitates the development, delivery, and evaluation of health interventions.
Results
After screening a total of 8220 articles, four studies were deemed relevant for the purposes of this review. The selected studies were the only ones that discussed nutrition interventions or programs with a very clear aim and purpose, even though they did not include any information on implementation, review or evaluation of these interventions/program. No studies focusing on the African context were deemed relevant as none of them focused on best practice models for nutrition education interventions or programs.
Conclusions
Of a review of over 8220 articles, four studies were found that discuss nutritional feeding programs and nutritional models used by primary caregivers. Of these four, only one focused on enablers, barriers, and resources, all of which are essential for engaging in health behavior change. And only one focused on sustainability of the interventions.
... RE-AIM has been successfully used in other systematic reviews evaluating the public health impact of interventions targeting, e.g. physical activity, 20,21 childhood obesity, 22,23 dietary intake, 24 diabetes selfmanagement, 25 health literacy 26 and mood disorders. 27 The purpose of this article was to conduct a systematic literature review using the RE-AIM framework to provide a comprehensive evaluation of the external validity and dissemination potential of Internet-based ED preventive interventions targeting adolescents. ...
... It remains largely unclear whether ED prevention programmes are able to reach adolescents who are most in need of prevention, as highlighted in other reviews of prevention programmes. 20,22,24 The samples included in the studies reviewed were predominantly female, which could reflect the higher prevalence of ED risk in girls, girls agreement to participate, or studies that exclude boys. To increase reach across the adolescent population, ED prevention programmes might consider genderspecific content and designs to enhance reach among boys. ...
Background:
Past research has yielded promising results on the effectiveness of Internet-based interventions to prevent eating disorders (EDs) in adolescents, but further information is needed to evaluate the public health impact of their large-scale dissemination. This article used an established framework to systematically review the extent to which indicators of the reach, effectiveness, adoption, implementation and maintenance [cf. Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM)-framework] of universal and targeted online ED prevention programmes are reported in the literature, in order to estimate their future dissemination potential.
Methods:
The literature search was conducted on PubMed, Web of Science and PsycINFO, and complemented by searching existing reviews and the reference lists of the studies included. Twenty-two studies published between 2000 and April 2019 met the inclusion criteria. We extracted data on a total of 43 indicators, within RE-AIM dimensions for each article, including qualitative coding of fostering and hindering factors.
Results:
Reach (55.0%) and implementation (54.0%) were the dimensions reported on most frequently, followed by effectiveness (46.8%), adoption (34.7%) and maintenance (18.2%). While internal validity indicators were frequently reported (e.g. sample size, effects and intervention intensity), most studies failed to report on elements of external validity, such as representativeness of participants and settings, adoption rates, implementation costs and programme sustainability.
Conclusions:
Evidence indicates that Internet-based ED prevention programmes can reach a large number of adolescents and can be feasibly implemented in school settings. However, given the paucity of large-scale dissemination studies available for review, the degree to which schools are willing to adopt preventive interventions, as well as the transferability of programmes to different settings and geographical regions remains unclear.
... Overall, the average inclusion rate of individual RE-AIM items in the present study was less than 16%, with a range of items reported across interventions. Variation in and underreporting of RE-AIM dimensions-particularly those related to external validity factors-have also been noted in other systematic reviews, including those focused on behavioral interventions (Harden, Gaglio, et al., 2015), obesity prevention and dietary interventions (Klesges, Dzewaltowski, & Glasgow, 2008;Schlechter, Rosenkranz, Guagliano, & Dzewaltowski, 2016), and physical activity interventions (Galaviz et al., 2014;Harden, Burke, et al., 2015). ...
... Within the Reach dimension of RE-AIM, whereas nearly half of the studies included in the review reported on exclusion criteria, only four studies reported on participation rate and/or representativeness. Lack of reporting in these areas is problematic given that this information is critical for assessments regarding the generalizability of interventions across settings, populations, and/or time (Schlechter et al., 2016). Misclassification of and errors associated with this dimension have been documented elsewhere (Gaglio, Shoup, & Glasgow, 2013;Harden, Gaglio, et al., 2015;Kessler et al., 2013). ...
Despite the benefits associated with regular participation in physical activity, individuals with spinal cord injury (SCI) remain insufficiently active. The ability to self-manage participation may increase physical activity levels, but only if self-management interventions can be implemented in the 'real world'. The purpose of this review was to examine the degree to which authors of published studies of LTPA self-management interventions for individuals with SCI have reported on factors that could increase the likelihood of translating this research into practice. A systematic search of five databases was conducted, yielding 33 eligible studies representing 31 interventions. Each intervention was assessed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework and the PRECIS-2 (PRagmatic-Explanatory Continuum Indicator Summary) tool. The most commonly reported RE-AIM dimensions were Effectiveness (51.0% of interventions) and Reach (18.5%), followed by Implementation (14.2%), Maintenance (13.8%), and Adoption (4.0%). Overall, interventions were scored as primarily explanatory in five of the nine PRECIS-2 domains (recruitment, primary analysis, organization, flexibility [delivery], follow-up) and primarily pragmatic in one domain (setting). These findings suggest that while some LTPA self-management interventions for individuals with SCI are intended to be translated to real world settings, limited information is available to understand the degree to which this has been accomplished. Enhanced reporting of factors that could increase the likelihood of translating these interventions into practice is recommended.
... Well-designed interventions can help parents make changes in their children's environments (Schlechter et al., 2016). Parents must be supported and involved in planned programs to make lasting changes in healthy eating habits. ...
The purpose of this study was to evaluate the effectiveness of web‐based nutrition education for parents of preschool children in reducing nutritional risk. The study was conducted in a one‐group pretest–posttest quasi‐experimental design. Parents of 3–5‐year‐old children from 11 preschools in Istanbul participated. They underwent a web‐based nutrition education program. The NutriSTEP assessment tool was used to evaluate the nutritional risk score as a pretest assessment, followed by the training program. Posttests were conducted at 1‐ and 3‐month intervals. Before the intervention, 55.8% of the children exhibited high nutritional risk. After the intervention, this percentage decreased significantly at the 1‐month and 3‐month follow‐ups, with 94.2% and 93.6% of the children classified as low risk, respectively. The analysis also revealed significant associations between children's eating behaviours and factors such as maternal education, family income and family structure. As a result, web‐based nutrition education was effective in reducing nutritional risk among preschool children. The findings underscore the importance of using technology for nutrition interventions, especially in diverse populations. The training program's simple, short and understandable video increased participants' interest in the training and encouraged regular follow‐up.
... 8,9 However, there is limited data on effective and sustainable strategies to engage families in changing children's behaviors, although studies suggest that strategies with indirect engagement (ie, sending information) are less effective than strategies requiring direct engagement (ie, facilitating supportive environments). [10][11][12] Moreover, parents play a critical role in developing youth health beliefs and behaviors. 13,14 Behavior change in adult family members with diabetes can have positive effects on the entire household. ...
Objective
Despite growing numbers of initiatives designed to address increasing diabetes prevalence in the U.S., the need remains for effective programs. Because family history is a diabetes risk factor, family focused programs may be a potential strategy to improve the health of the entire family. We present the development process and pretest results of a lifestyle change program for rural-dwelling mothers at risk for diabetes and their children.
Methods
We completed semistructured interviews with mothers ( N = 17) focusing on program content and activities. Findings informed program development by identifying specific barriers motivators and potential leverage points such as focusing on the intrinsic incentives of health activities. The resulting program was pretested with rural-dwelling mothers ( N = 5) who completed program activities with their families and provided feedback via semistructured interviews. All interviews were audio-recorded, transcribed, and analyzed using thematic analysis.
Results
While pretest results showed that the program was generally acceptable and feasible, feedback was used to further refine the program. The revised program consists of 8 group sessions with family focused content around physical activity, healthy eating, and making connections while engaging in health activities. Between sessions, mothers tracked the family goals, activity levels, and mood, and documented barriers to discuss during the sessions.
Conclusions
Our development process engaged intended program users to codesign a program that focuses on wellness and intrinsic incentives of engaging in health-enhancing activities as a family. By providing strategies to change behaviors as a family, this program aims to improve the mother's health while developing healthy habits in their children.
... org/ learn/ what-is-re-aim/ ) and previous applications of the framework in health-related systematic reviews. [55][56][57] Frequency counts and percentages were recorded for each RE-AIM component, and means were calculated for each RE-AIM indicator using Microsoft Excel 365. ...
Cancer genomic services (CGS) can support genetic risk‐stratified cancer prevention and treatment. Racial/ethnic minority groups are less likely to access and utilize CGS compared with non‐Hispanic Whites. Little research has described characteristics of interventions targeted at CGS among Latinos. This scoping review aimed to (1) describe interventions promoting uptake of CGS among Latinos in the United States and Latin America, (2) describe intervention adaptations for Latino participants, and (3) summarize intervention implementation factors suggested by reach, effectiveness, adoption, implementation, and maintenance (RE‐AIM) framework. We conducted a search in English and Spanish of literature published between 2005 and 2022 across PubMed and Latin American and Caribbean Health Sciences Literature databases. Sixteen of 2344 papers met the inclusion criteria of the analysis. Efforts to promote CGS among Latino communities were limited in the US and lower in Latin America. This review highlights the need for in‐depth exploration of acculturation‐informed interventions and better reporting on implementation factors to enhance their scalability across diverse settings.
... Children's eating habits are closely related to behaviors at home, specifically to the parenting and eating styles of the parents [44]. For this reason, interventions that can be targeted at parents or involving them could offer many opportunities in enhancing healthy eating practices by children, such as increasing the consumption of fruits and vegetables [45]. ...
Background
The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions.
Objective
This study aims to explore schoolchildren’s knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating.
Methods
A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated.
Results
We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren’s homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren’s homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children’s knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate.
Conclusions
The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers’ perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren’s nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating.
... As we were able to corroborate, students improved their knowledge in this area and increased healthy intake. In this sense, Schlechter et al. (2016) affirmed that school environments and families are two essential factors in modifying adolescents' dietary behaviours. ...
Introduction/Objectives:
Obesity rates are reaching alarming levels. Adolescence is a critical period for the prevention of nutritional problems, as it is a time of development of one’s own eating habits. These habits will persist into adulthood, so showing adolescents healthy lifestyle patterns is important. The ideal option would be through school-based nutrition intervention programmes. The main objective of this article is to investigate the effectiveness of intervention programmes based on nutritional knowledge and the behaviour of adolescents aged 11-19 years.
Method:
To carry out this systematic review we employed Scopus, PubMed, and Web of Science as databases and a search period that spanned the last 10 years, following the PRISMA statement. Subsequent to the search, 110 articles were found. Finally, 19 articles were selected for in-depth analysis after a thorough screening.
Results:
The results show that, in general, intervention programmers have improved the nutritional knowledge of high school students, which means an improvement in their eating behaviours. In addition, these programmes increase their levels of physical activity. However, gender differences are observed, with girls being more concerned about maintaining a balanced diet.
Conclusion:
In conclusion, schools are an ideal environment for developing programmes that interfere in adolescent eating behaviour.
... 130 There is a robust literature applying RE-AIM to evaluate the implementation of other child health interventions. 131,132 Currently, there is one adult-focused Veterans' Affairs-funded study using a stepped-wedge, hybrid III effectiveness-implementation design to compare the impact of training primary care mental health integrated clinicians in the delivery of BBT-I versus this BBT-I training plus 12-months of access to an implementation strategy bundle (BBT-I+IS) (I01HX003096 PI: Bramoweth). RE-AIM was used to guide the study design and outcomes, which include the number of Veterans with access to BBT-I in primary care by study arm (BBT-I vs. BBT-I+IS). ...
Study objectives:
This review synthesizes the pediatric behavioral sleep intervention (BSI) evidence base, summarizes challenges in translating BSIs from research to practice, and provides recommendations for integrating Implementation Science (Imp Sci) methods to advance pediatric BSI research.
Methods:
We briefly review the common behavioral sleep disturbances among youth, discuss the pediatric BSIs with well-established evidence, and identify gaps in pediatric BSI research. We then identify contributors to the dearth of research evaluating pediatric BSIs in accessible settings and present a model for applying Imp Sci strategies to address identified gaps across the continuum of translational research.
Results:
Relatively few BSI trials include older children and adolescents. Similarly, there is limited research evaluating BSIs among racially and ethnically minoritized children and families and/or those of lower socioeconomic status backgrounds. Access to scalable and easily disseminable tools to treat pediatric sleep disturbances early in their development is crucial for promoting positive child outcomes. To address these gaps, researchers should apply Imp Sci theories, models, and frameworks to design new interventions for implementation, adapt existing interventions with end-users and settings in mind, conduct hybrid effectiveness-implementation trials, and test implementation strategies.
Conclusions:
Given the prevalence and consequences of poor sleep across developmental periods, pediatric BSIs must be effective as well as adaptable, scalable, and easily disseminable. Imp Sci theories, models, and frameworks can enhance access to, engagement in, and the implementation and dissemination of scalable BSIs across diverse pediatric care settings and heterogeneous populations.
... As we verified, they improve students' knowledge about healthy diets and foster healthy attitudes and behaviors in their lives. School environments and families are essential in promoting healthy habits and modifying dietary behaviors [89,90]. However, it is more important to include fun and interactive activity-based nutrition sessions [91] because attitude, which is influenced by motivation [92], mediated eating behaviors [93]. ...
Childhood obesity and overweight rates are increasing in an exponential way. This type of diet-related health problem has consequences, not only at present but also for children’s future lives. For these reasons, it is very important to find a solution, which could be nutrition intervention programs. The main objective of this article is to investigate the effectiveness of nutrition intervention programs in children aged 3–12 around the world. We used SCOPUS, Web of Science, and PubMed databases to carry out this systematic review and we followed the PRISMA statement. Two authors conducted literature searches independently, finding a total of 138 articles. Finally, after a thorough screening, a total of 19 articles were selected for detailed analysis. The results show that, in general, nutrition intervention programs are effective in improving knowledge and behaviors about healthy habits, and, consequently, that the body mass index value is reduced. However, it is true that we found differences between the incomes of families and geographical areas. In conclusion, we encourage school centers to consider including these types of programs in their educational program and bring awareness of the importance of families too.
... Findings from the ENCIRCLE study will also inform dissemination strategies to best engage parents, primary care clinics, and PCPs in PRO measure collection, preventive counseling, and community referrals based on the RE-AIM framework [35,62]. Despite the importance of examining intervention implementation, a systematic review of child dietary interventions with a parent component found a concerning lack of reporting on RE-AIM elements, particularly those related to external validity [67]. This lack of reporting on implementation constrains effective translation of interventions into primary care, thus limiting the potential population health impact of these interventions. ...
Background
Obesity disproportionally impacts rural, lower-income children in the United States. Primary care providers are well-positioned to engage parents in early obesity prevention, yet there is a lack of evidence regarding the most effective care delivery models. The ENCIRCLE study, a pragmatic cluster-randomized controlled trial, will respond to this gap by testing the comparative effectiveness of standard care well-child visits (WCV) versus two enhancements: adding a patient-reported outcome (PRO) measure (PRO WCV) and PRO WCV plus Food Care (telehealth coaching and a grocery store tour).
Methods
A total of 2,025 parents and their preschool-aged children (20–60 months of age) will be recruited from 24 Geisinger primary care clinics, where providers are randomized to the standard WCV, PRO WCV, or PRO WCV plus Food Care intervention arms. The PRO WCV includes the standard WCV plus collection of the PRO—the Family Nutrition and Physical Activity (FNPA) risk assessment—from parents. Parents complete the PRO in the patient-portal or in the clinic (own device, tablet, or kiosk), receive real-time feedback, and select priority topics to discuss with the provider. These results are integrated into the child’s electronic health record to inform personalized preventive counseling by providers. PRO WCV plus Food Care includes referrals to community health professionals who deliver evidence-based obesity prevention and food resource management interventions via telehealth following the WCV. The primary study outcome is change in child body mass index z-score (BMIz), based on the World Health Organization growth standards, 12 months post-baseline WCV. Additional outcomes include percent of children with overweight and obesity, raw BMI, BMI50, BMIz extended, parent involvement in counseling, health behaviors, food resource management, and implementation process measures.
Discussion
Study findings will inform health care systems’ choices about effective care delivery models to prevent childhood obesity among a high-risk population. Additionally, dissemination will be informed by an evaluation of mediating, moderating, and implementation factors.
Trial registration
ClinicalTrials.gov identifier (NCT04406441); Registered May 28, 2020.
... There is a need to evaluate process data to further explore and explain these results so that any future decisions related to the potential scale-up of these interventions are fully informed. Process evaluations are critical to providing a comprehensive assessment of interventions alongside effectiveness testing, helping to determine how interventions work, whom they work for, how outcomes can be explained, and how interventions can be improved in the future, which are important considerations for policy and practice [10]. To date, a very limited number of studies have conducted process evaluations of children's healthy eating and active living translation trials [11][12][13]. ...
BACKGROUND
Few translational trials have provided detailed reports of process evaluation results.
OBJECTIVE
This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children.
METHODS
Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P <.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively.
RESULTS
Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention.
CONCLUSIONS
This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
... We identified 31 RCTs testing psychosocial interventions for breast cancer-related pain. Consistent with similar evaluation studies investigating interventions for health behaviors such as diet (Schlechter et al., 2016) and physical activity (McGoey et al., 2016;White et al., 2009), dimensions related to individual-level indicators (i.e., reach and effectiveness) were most reported, with each dimension having an average reporting rate of over 60%. Comparatively, dimensions reflecting setting-level data of these intervention studies (i.e., adoption, implementation, and maintenance) were lacking, with some individual indicators not reported at all. ...
Psychosocial interventions for breast-cancer-related pain are effective, yet over 45% of survivors continue to struggle with this often-chronic side effect. This study evaluated multilevel indicators that can influence successful translation of interventions into clinical practice. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was applied to evaluate reporting of individual and setting/staff-level intervention indicators. A systematic search and multi-step screening process identified 31 randomized controlled trials for psychosocial interventions for breast cancer-related pain. Average reporting of indicators for individual-level dimensions (Reach and Effectiveness) were 65.2% and 62.3%, respectively. Comparatively, indicators for setting/staff-level dimensions were reported at a lower average frequency (Implementation, 46.8%; Adoption, 15.2%; Maintenance, 7.7%). Low reporting of setting/staff-level dimensions suggests gaps in the sustained implementation of psychosocial interventions. Implementation science methods and frameworks could improve trial design and accelerate the translation of psychosocial interventions for breast cancer-related pain into clinical practice.
... There is a need to evaluate process data to further explore and explain these results so that any future decisions related to the potential scale-up of these interventions are fully informed. Process evaluations are critical to providing a comprehensive assessment of interventions alongside effectiveness testing, helping to determine how interventions work, whom they work for, how outcomes can be explained, and how interventions can be improved in the future, which are important considerations for policy and practice [10]. To date, a very limited number of studies have conducted process evaluations of children's healthy eating and active living translation trials [11][12][13]. ...
Background
Few translational trials have provided detailed reports of process evaluation results.
Objective
This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children.
Methods
Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P
... rule-setting, behavioural consequences, establishing behavioural expectations) and their control of the home environment. 51,52 Interventions that target both the child and the family are particularly effective, 29,53,54 and without the involvement of family members it is unlikely that a change in children's physical activity levels will be maintained long term. 44,55,56 Thus, targeting whole families may create a more supportive, synergistic environment for the promotion of healthy behaviours, 29,57 from which wider family members may also be able to benefit. ...
Background
Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.
Objectives
To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.
Design
The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.
Setting
Norfolk/Suffolk counties, UK.
Participants
Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.
Interventions
The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.
Main outcome measures
Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.
Data sources review
Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).
Review methods
Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.
Inclusion criteria
Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.
Results
The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.
Limitations
Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.
Conclusions
This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.
Future work
Further refinements to intervention delivery and recruitment methods should be investigated.
Study registration
Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.
... The RE-AIM framework has been used recently in several systematic reviews to evaluate the internal and external validities of health intervention studies such as weight management intervention [18], physical activity intervention [22,23], worksite health behavior interventions [24], community settings [20], school-based health promotion [25,26], childhood obesity prevention [27][28][29], children dietary interventions with parents [30], injury prevention strategies [31], faithbased intervention [32], mobile phone-based intervention for diabetes self-management [33] and HIV prevention intervention [34]. While encouraging, there is little reporting on its potential use for translating HPV vaccination social media-driven intervention methods into regular practice settings, specifically at the population level. ...
Social media HPV vaccination interventions show promise for increasing HPV vaccination rates. An important consideration for the implementation of effective interventions into real-world practice in the translation potential, or external validity, of the intervention. To this end, we conducted a systematic literature review to describe the current body of evidence regarding the external validity of social media HPV vaccination-related interventions. Constructs related to external validity were based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. Seventeen articles published between 2006 and 2020 met inclusion criteria. Three researchers independently coded each article using a validated RE-AIM (reach, effectiveness/efficacy, adoption, implementation, maintenance) framework. Discrepant codes were discussed with a fourth reviewer to gain consensus. Of these 17 studies, three were pilot efficacy studies, 10 were RCTs to evaluate effectiveness, one was a population-based study, and three did not explicitly state which type of study was conducted. Reflecting this distribution of study types, across all studies the mean level of reporting RE-AIM dimensions varied with reach recording 90.8%, effectiveness (72.1%), adoption (40.3%), implementation (45.6%), and maintenance (26.5%). This review suggests that while the current HPV vaccination social media-driven interventions provide sufficient information on internal validity (reach and effectiveness), few have aimed to gather data on external validity needed to translate the interventions into real world implementation. Our data suggest that implementation research is needed to move HPV vaccination-related interventions into practice. Included in this review are recommendations for enhancing the design and reporting of these HPV vaccination social media-related interventions.
... It has been shown bene cial for evaluating behavioural change interventions and assessing implementation impact [28][29][30]. The RE-AIM framework has been widely used in reviews of literature to evaluate several behaviour change and public health interventions including (but not limited to) interventions directed at health literacy [31], physical activity [32,33], community health [34] and nutrition [35]. In our review, data were extracted using a widely used [28,30] RE-AIM coding sheet for systematic reviews published on the RE-AIM website (http://www.re-aim.org/resources-and-tools/measures-and-checklists/ ...
Background. Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in people with cancer. Whilst efficacy of interventions for CRF have been extensively investigated, less has been done to ensure successful translation into routine clinical practice. The aim of this systematic scoping review was to synthesise knowledge surrounding the implementation of CRF interventions, summarise the processes and outcomes of implementation strategies used, and identify opportunities for further research.
Methods. PubMed, Cochrane CENTRAL, EMBASE and CINAHL databases were searched through to December 2020. The Cochrane Effective Practice and Organisation of Care (EPOC) Group taxonomy and the RE-AIM Framework were used to guide the evaluation of implementation strategies and outcomes, respectively.
Results. Six studies were included. Three used implementation frameworks (PARIHS, KTA, Cullens & Adams’ Implementation Guide) to guide implementation. Overall, the implementation strategies used across all studies were reported to have directly resulted in immediate changes at the clinician level (e.g., increased clinician behaviours, self-efficacy, attitudes, knowledge of CRF management). No clear relationship was found between the use of implementation models and the number or type of implementation strategies used. For outcomes, Effectiveness and Implementation were the most highly reported RE-AIM measures followed by Reach then Maintenance. Adoption was the least reported.
Conclusions. Despite the high prevalence of CRF and evidence-based interventions for managing CRF, there is limited evidence informing the sustainable implementation of these interventions. There was an absence of external indicator reporting (e.g., start-up and ongoing intervention costs) in included studies, limiting the transability of study findings. Further, factors such as lack of clinician time, insufficient program funding, and unsustainable maintenance costs, were highlighted as key implementation barriers of CRF programs. This scoping systematic review emphasises the lack of quality CRF implementation studies presently available in the literature leading to a disconnect between effective CRF interventions, routine clinical care, and cancer survivors at present. Further, this review also highlights the need for robust study designs guided by established frameworks to methodically design and evaluate the implementation of CRF management interventions in the future.
... Parents are thought to influence children's development of long-term obesity risk behaviors, but parent-based obesity-prevention programs have had only modest success [1][2][3]. One understudied factor that may impact program delivery is parent stress, which could disrupt healthy weight-related parenting practices [4,5] or reduce the multiple attempts parents need to make for their children to develop taste preferences for vegetables and other healthy foods [6]. ...
Less than 1% of children in the United States concurrently meet guidelines for fruit/vegetable intake, physical activity, screen time, and sugar-sweetened beverages. Prior evidence suggests that parents of this 1% potentially cope with stress differently. This qualitative study used a positive deviance-based approach to locate mothers whose children avoided negative feeding outcomes despite being ‘high-risk’ for obesity. Semi-structured interviews were conducted in Spanish for two groups: low-income, Hispanic mothers whose children were normal weight and met recommendations for fruits/vegetables and physical activity (n = 5); and a comparison group whose children had obesity and did not meet guidelines (n = 8). Topics included weight-related parenting practices, attitudes toward health, and stress management. Interviews were transcribed, translated, and coded using NVivo for theoretically driven thematic analysis. Results suggested that mothers viewed stress differently. Mothers of healthy weight children believed stress could be prevented, such as by paying children more attention or directing one’s attention away from stressors; comparison group mothers tended to report stress about managing their child’s eating and about financial worries. Future research is needed to understand the underlying sources of these differences (e.g. personality traits, coping practices) and test whether stress prevention interventions can promote healthy parental feeding practices.
... Another aspect discussed in the literature is the role to be played by parents. Although there seems to be no consensus on this (Kelishadi & Azizi-Soleiman, 2014;Racey et al., 2016;Schlechter, Rosenkranz, Guagliano, & Dzewaltowski, 2016), most authors recommend that parents participate either directly or indirectly (Gómez-Castillo, López-Pina, Torres-Ortuño, López-Durán, & Ricarte-Trives, 2018;Kim, Park, Park, Lee, & Ham, 2016;Sisson et al., 2016). ...
Background:
Diet and physical activity are prioritised in behavioural interventions given their influence on major child health issues. The objective of this study was to assess the feasibility of an educational intervention, based on the Behaviour Change Wheel model, on adherence to healthy eating habits in adolescent soccer players in Asturias, Spain.
Method:
This pilot study involved 319 soccer players (mean age=14.19 years; SD=1.089), who were distributed into a control group (CG) and an intervention group (IG). The response variables were: the usage rate of, adherence to, and acquisition of knowledge of the Mediterranean diet. The intervention included posters, a web-app, and practical activities.
Results:
The mean score on the knowledge questionnaire was 2.53 for the CG and 3.42 for the IG (p <.001). A weak direct correlation was observed between diet knowledge and KIDMED scores (r =.222, p =.013). The total pre-test KIDMED (p <.001) and diet knowledge ( p =.05) scores explained approximately 33% of the total post-test KIDMED score.
Conclusions:
The combined use of posters and a web app as intervention tools have been shown to be feasible in order to provide information on healthy eating habits to adolescents who play soccer and to help them maintain those eating habits.
... For example, Antikainen et al. (27) found that among theory-based PA intervention studies, organizational maintenance was reported in only 5% (n = 3) of studies. The reporting of organizational maintenance in childhood and youth PA, diet, and obesity studies has also been low (28)(29)(30)(31). Harden et al.'s systematic review of behavioral interventions found that there was insufficient data to determine the average organizational maintenance for the 82 interventions included (32). ...
Introduction: Despite the important role that faith-based organizations can play in eliminating health disparities, few studies have focused on organizational change and maintenance of interventions in this setting, making their long-term impact unknown. This study reports 24-month maintenance of the Faith, Activity, and Nutrition (FAN) program in a southeastern county. Previously reported findings of reach, adoption, implementation, and effectiveness are also summarized.
Methods: Church coordinators from 35 intervention churches (97% predominantly African American) located in a rural, medically underserved county in South Carolina were interviewed at baseline (2015), and 12- and 24-months post-training regarding implementation of physical activity (PA) and healthy eating (HE) components of the FAN program. Guided by the RE-AIM framework, organizational maintenance was defined as church coordinator-reported 24-month implementation of the four FAN components (providing opportunities, setting guidelines/policies, sharing messages, engaging pastor). Repeated measures analyses (mixed models) examined change in implementation over time. Churches were also classified as maintainers, non-sustained implementers, and low implementers for each FAN component. Statistical analyses were conducted in 2019.
Results: Church coordinators reported significantly greater implementation of both PA and HE FAN components at 12 and 24 months compared to baseline (medium to large effects). The percentage of churches classified as maintainers ranged from 21 to 42 and 27 to 94% across PA and HE components, respectively. Most churches (58% for PA, 97% for HE) were maintaining at least one FAN component at 24 months.
Conclusions: These promising findings position FAN well for the national implementation study now underway.
Trial Registration: This study is registered at www.clinicaltrials.gov NCT02868866.
... Preschool children have little to no ability to adequately influence changes in parenting styles, dietary practices, or community characteristics (Hingle, O'Connor, Dave, & Barnowski, 2010;Kim, Schulz, Zimmermann, & Hahlweg, 2018;Schlechter, Rosenkranz, Guagliano, & Dzewaltowski, 2016). Therefore, the theoretical model used for this review of the literature was the Socioecological Model (SEM) proposed by Bronfenbrenner (1986) and since modified to address obesity (CDC, 2018). ...
Objectives:
The objectives of this systematic review of literature include: (a) describe the intervention strategies; (b) examine the outcomes as they pertain to the child (individual level), families (interpersonal level), and community or culture (organizational level); and (c) develop a foundation of interventional approaches that specifically target obesogenic behaviors in Hispanic preschool-aged children.
Design:
A systematic review of literature was performed. The theoretical framework was the Socioecological Model.
Sample:
Twenty-four total articles were used for this review.
Measurements:
The method used was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results:
Of the 24 studies reviewed, 36% focused on the individual, 56% were interpersonal (focused on parents), and 9% focused on the organizational level.
Conclusion:
Interventions that are culturally competent, directed at families, and include healthy dietary intake along with a physical activity component are most effective at lowering obesity in Hispanic preschool children.
... Existing family-based behavioral interventions to prevent pediatric obesity demonstrated only modest effects on improving children's EBRBs (Brown et al., 2016;Marsh, Foley, Wilks, & Maddison, 2014;Schlechter, Rosenkranz, Guagliano, & Dzewaltowski, 2016). These programs frequently applied indirect strategies to involve parents as change agents and did not directly address important parenting practices to improve child EBRBs. ...
Latino adolescents face challenges to performing energy balance–related behaviors (EBRBs) to prevent childhood obesity, including healthy dietary intake, adequate physical activity, and limited screen time. Fathers are underrepresented in family-based obesity interventions but could be influential in shaping the EBRBs of Latino children. Three types of parenting practices (setting expectations/limits, role modeling, managing availability and accessibility) have shown relatively consistent positive relationships with children’s EBRBs in studies that have mostly involved mothers. The purpose of this study was to develop measures to assess Latino fathers’ parenting practices based on existing measurement instruments, focus groups and cognitive testing. Criterion validity of the measures (40 items) was examined with Latino fathers and their early adolescents (10-14 years old, n = 96 dyads) who were predominantly from low-income, two-parent households. Criterion validity was indicated by significantly higher intakes of fruit and vegetables; lower intakes of sugar-sweetened beverages, sweets/salty snacks and fast foods; more weekly physical activity hours; and fewer daily screen time hours among adolescents who reported high versus low levels/frequencies of supportive parenting practices. In addition, nearly all scales of adolescent-reported paternal behavioral modeling and availability/accessibility practices were significantly correlated with adolescents’ corresponding EBRBs (r = 0.22 to 0.54). However, poor validity and agreement with early adolescents’ reports were found for most father-reported parenting practices. Overall, this study indicated that the measures were acceptable for assessing adolescents’ report of Latino fathers’ parenting practices around EBRBs. The findings also indicate the importance of including early adolescents’ reports in measuring paternal parenting practices.
... Based on individuallevel implementation science model, 53 three stages of ''delivery, receipt, and enactment'' must be reported to not blame on intervention components or materials in unsatisfying outcomes. 54 Thus, it is necessary to make sure that all the three stages of implementation are completely performed through process evaluation for a successful implementation of the training material. Furthermore, engaging parents is better to be aligned with motivation for seeking health information and readiness for change. ...
Background:
Home environment, modeling of weight-related behaviors, and general parenting style are very important predictors of obesity in children. The effect of parent engagement in prevention of obesity in children is not clear. The main objective of this systematic review was to address the effects of parent engagement in obesity prevention interventions on anthropometric changes among preschool children.
Methods:
PubMed/Medline, Cochrane Library, ISI Web of Knowledge, Scopus, Science Direct, and Google Scholar were searched. Eligible studies were randomized controlled trials in last 10 years (from 2008 until February 14, 2018), which had a parent engagement in obesity prevention interventions (as an intervention) and children's anthropometric indices (as an outcome).
Results:
Twenty-six studies were included. Half of studies targeted both parents and children, and the rest targeted only parents. Types of interventions ranged from a simple motivational interviewing to professional skill training approaches. Studies that targeted overweight or obese children in their intervention containing training sessions followed by maintenance for parents and those that focused on individual support for overweight children and their parents, resulted in higher improvement in BMI and other outcomes.
Conclusions:
Anthropometric indices and BMI are not appropriate for reflecting the effectiveness of parent engagement in obesity prevention interventions. Having an individual component in the intervention and focusing more on parents vs. children in the intervention may result in improvement in anthropometric outcomes. Focusing on weight-related behaviors as the main outcome in both, children and parents, rather than anthropometric indices, is highly recommended for future reviews.
... Similar to other reviews of the literature that have used evaluation frameworks such as RE-AIM (www.re-aim.org) to examine factors associated with external validity (i.e., reach, implementation) [23,53], less than half of the interventions reviewed here reported on variables related to generalizability, including setting or racial representativeness. This remains concerning for researchers and practitioners who look to the literature to adopt evidence-based programs. ...
Purpose
To increase physical activity (PA), interventions based on group dynamics may be superior to interventions that target aggregates of people but do not have formal strategies to enhance cohesion. This review examined the extent to which group dynamics processes have been integrated within exercise and/or PA interventions in cancer survivors, and explored the implementation and effectiveness of these interventions for increasing PA.
Methods
A systematic review was conducted of English articles published January 2005–March 13, 2017 using the electronic databases PsycINFO, CINAHL, and PubMed Medline (National Library of Medicine). Studies in adult cancer survivors that had a controlled or uncontrolled experimental design, included face-to-face exercise, had a group-based component, and reported PA pre- and post-intervention were included. Self-reported PA effect sizes were estimated for pre- to post-intervention, separately for studies that implemented ≥ 1 group dynamics strategy versus none.
Results
Twenty-three studies were reviewed, 34.8% (n = 8) included ≥ 1 group dynamics strategy (M = 1.6 ± 0.7, range = 1–3). Most interventions were delivered in a healthcare or rehabilitation setting by an exercise professional, and face-to-face exercise dose ranged from 72.0–6000.0 min. PA effect size ranged from 0.3–1.2 for studies that implemented ≥ 1 group dynamics strategy versus 0.4–2.4 for those with none. Studies reviewed lacked detailed examples of group dynamics strategies, and none measured group cohesion.
Conclusions
The additional benefit of group dynamics–based interventions for increasing PA in cancer survivors remains unclear. More research is needed to enhance the generalizability of face-to-face exercise interventions, and determine how to maximize the potential of including group dynamics strategies.
... of strategies including discussion, role modelling and repetition to support understanding and uptake.45,46 Some parents reported changed practices such as children's drinks, snacks or routines around sleep, whilst others prioritised outdoor play, or set limits to electronic screen access. ...
Issue addressed
Health and nutrition inequalities are prevalent among families from socio‐economically disadvantaged backgrounds. However, there is limited evidence of targeted early childhood nutrition and active play approaches due to the methodological challenges in engaging vulnerable families in research.
Methods
The aim of this paper is to report findings from a pilot intervention called Confident and Understanding Parents (CUPs). CUPs aims to improve child nutrition and active play‐related outcomes for children in vulnerable families. The intervention was delivered in six Supported Playgroups (SPs) in two disadvantaged locations in Victoria. Surveys incorporated knowledge and confidence measures and were administered pre‐ and post‐training of SP facilitators along with pre‐, immediately post‐ and 3 months post‐intervention to SP facilitators and parents. Qualitative data were collected via debriefing discussions with SP facilitators and ethnographic observations during SP sessions. Thematic analyses of qualitative data and statistical quantitative analyses were conducted.
Results
Nine SP facilitators completed training, of whom six delivered CUPs in SPs with 64 parents of children aged 0 to 4 years from socially‐disadvantaged backgrounds. Forty‐three parents (66%) attended a minimum of 50% of SP sessions with CUPs delivery. SP facilitators and parents demonstrated improved knowledge and confidence following the pilot. Learnings for implementation were identified.
Conclusion
Overall, the CUPs intervention reached and engaged vulnerable families. A strength of the intervention is the flexibility offered to SP facilitators in selecting key messages and the strong focus on “local” translation of key child nutrition and active play messages within existing early childhood settings. A further strength was the adaptation of evaluation methodology to optimise the engagement of vulnerable families.
So what?
This pilot study provides insights about engaging vulnerable families in a nutrition and active play intervention to promote child health. These promising findings warrant further implementation and rigorous evaluation of CUPs.
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... Findings from these studies are mixed; some show a positive intervention effect on children's eating or growth, while many do not [17,18]. The variability in effectiveness of interventions has been ascribed to their differing theoretical frameworks, differences in implementation and fidelity of the interventions, as well as wide variation in the outcomes assessed (and the rigor of these assessments) across interventions [19]. ...
Purpose of Review
Children’s eating behaviors are critical determinants of their dietary intake and, hence, childhood growth. Nutritional interventions among families with young children are focused on parents as agents of change, with interventions increasingly targeting family routines as drivers of children’s eating and health outcomes. This review describes studies that have acted on family routines in the context of preschoolers’ eating and growth, summarizes their findings, and discusses the limitations of current approaches to studying family routines and the implications for future research.
Recent Findings
We found that food availability and parental offering of foods have been modified by several interventions and linked to positive changes in child outcomes. Parent interventions have had success in reducing controlling feeding practices and improving self-efficacy related to child feeding, but these have not been associated with long-term change in child outcomes.
Summary
We conclude that opportunities exist to strengthen the definition, operationalization, and measurement of family routine variables. Improvements in fidelity and process evaluation measures will be important for more efficacious intervention development and dissemination.
Objective
Evaluate the effectiveness of the multicomponent intervention trial “Are You Too Sweet?” in reducing discretionary foods and drinks intake among young schoolchildren.
Design
The study was a 3.5-month two-arm cluster randomised controlled trial among primary school children and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilize at home. Dietary intake was assessed using a web-based seven-day dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups.
Setting
Six schools from a Danish municipality were randomised to the intervention group ( n 4) or the control group ( n 2).
Participants
A total of 153 children aged 5-7 years.
Results
No significant reduction in the children’s intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40.9% (p = 0.045) was observed compared to control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2.9 E% (p = 0.002).
Conclusion
The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.
Introduction
Africa's young people are among the least focused groups in healthcare linkage. The disproportionally high burden of youth-related health problems is a burden, especially in developing regions like Africa, which have a high population of young people. More information is needed about factors that impact linkages in healthcare and the sustainability of health interventions among young people in Africa.
Methods
A systematic literature search was performed from October 2020 to May 2022 in PubMed, CINAHL, Scopus, Global Health, and the Web of Science. Studies included in the review were conducted among young people aged 10–24 living in Africa, written in English, and published between 2011 and 2021. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data was analyzed using narrative synthesis, synthesizing the details of the RE-AIM reporting component. Interventions were systematically compared using the Cochrane Collaboration risk-of-bias tool to evaluate the rigor of each intervention.
Results
A total of 2,383 potentially relevant citations were obtained after an initial database search. Retained in the final group were seventeen articles from electronic data searches; among these articles, 16 interventions were identified. Out of the seventeen studies, nine (53%) were randomized controlled trials, three (18%) were quasi-experimental designs, and five (29%) were observational studies. At the same time, the included interventions were reported on 20 (76.92%) of the 26 components of the RE-AIM dimensions. In eastern Africa, twelve (80%) interventions were conducted, and all the interventions addressed linkage to care for young people in preventing and treating HIV. The least reported RE-AIM dimensions were implementing and maintaining interventions connecting young people to care.
Discussion
Timely care remains critical to treating and preventing ailments. This review indicates that interventions created to link young people to care, especially HIV care, can help link them to health care and strengthen the programs. It is also clear that further research with more extended follow-up periods is needed to examine connections to care in all other aspects of health and to bridge the gap between research and practice in the care of young people in Africa.
Systematic Review Registration
PROSPERO [CRD42022288227].
Introduction
The patient-physician encounter is the core element in the treatment of patients and the diagnosis of disease. In these times of digitalization, patient-physician communication is increasingly taking place online: patients embrace new possibilities offered digitally, and physicians are encouraged to adapt accordingly. Since a huge part of online communication is written, this study aims to investigate how medical students communicate with patients online by focusing on their written competencies and whether an intervention might improve their competencies.
Methods
This study was performed in an explanatory cross-sectional manner with a cross-over design. Second-year medical students participated. An intervention was developed on how to formulate an appropriate written response to a patient’s request and integrated a longitudinal communication class. The intervention consists of education on general set-up (e.g., greetings), syntax, spelling, content and kind of communication (e.g., appreciative attitude). After meeting a patient in a simulated role play medical students received the patient’s request via a digital platform. The control group had the same simulated role play and the same task but they received the intervention on communication afterwards. Intervention and control group were statistically compared based on a checklist.
Results
Twenty-nine medical students took part in the study. The results showed that the medical students had basic competencies in dealing with written communication independent if they received the intervention (CG: M = 3.86 ± 1.23 vs. IG: M = 4.07 ± 1.03; p = 0.625). Similar results were also for the emotional competency ratings (MCG = 3.36 ± 1.08; MIG = 3.67 ± 0.98; p = 0.425).The intervention was able to lead to a more appreciative response toward patient.
Discussion
Intervention on basic competencies such as simple language and clear presentation might not be needed as an integral part in medical education. However, medical students should learn how to present empathic and authentic behavior in written online communication.
Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
Latino children have a disproportionately high prevalence of obesity. Parenting styles and food- and activity-related parenting practices influence children’s weight and weight-related behaviors. Fathers are underrepresented in existing healthy lifestyle intervention studies for families. The Padres Preparados, Jóvenes Saludables program was designed with an emphasis on paternal involvement for preventing childhood obesity among early adolescents. It offers eight weekly sessions delivered by Extension educators at community sites, with major topics of parenting skill training, positive parent-adolescent relationships, and healthy lifestyles related to healthy eating, physical activity, and screen time. The current study described pilot testing of the program for feasibility with a small sample of families in the Spring of 2017. Of the thirteen parents enrolled in the program, nine families, including all fathers, completed the program by attending five or more sessions and pre- and post-intervention evaluation sessions. Participant feedback indicated that program satisfaction was high. Participants also reported positive behavioral changes related to dietary intake, food- and activity-related parenting practices, and general parenting style. Findings demonstrated the feasibility of the program for engaging Latino fathers in promoting healthy lifestyle behaviors among early adolescents.
Parents can be essential change-agents in their children’s lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the
effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
Objective:
The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework.
Introduction:
An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments and/or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine interventions' functional characteristics and how they can influence emergency department clinicians' behaviors related to suicide-prevention care.
Inclusion criteria:
This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude.
Methods:
This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behavior Change Wheel's intervention functions. Reported outcome measures were categorized. Findings are tabulated and synthesized narratively.
Results:
Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. In summary, this review included a total of 70 citations, describing 66 different interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivisation (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), and/or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches.
Conclusions:
Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and/or organization-level barriers for a given context. Secondly, the ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors, but current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
Objective
The present study aimed to assess whether six months intervention program with parents' implication in primary schools is able to decrease morning snack consumption among children aged 6–12 years.
Methods
We carried out a quasi-experimental study with two groups of schoolchildren in the region of Sousse (Tunisia) from 2015 to 2016. One primary school in each group was selected. In each school, we randomly selected a sample size of schoolchildren and their parents. The intervention was based on healthy eating habits promotion.
Results
The consumption of morning snacks the day before data collection, reported by children, decreased significantly in post-intervention in both intervention and control groups . The decrease of consumption of morning snacks was significantly higher in intervention group (p=0.009). According to parents, the proportion of children who had the habit of eating morning snack decreased significantly from pre to post-intervention in intervention group (p<0.001).
Conclusion
A healthy environment should be created through effective school policies to prevent obesity.
Lack of compliance with dietary and activity guidelines contributes to the high prevalence of overweight and obesity among adolescents. Intervention programs need enhanced strategies to promote healthy lifestyle behaviors. Although adolescents have more autonomy than younger children, parents still play an important role in influencing adolescents' energy balance-related behaviors (EBRBs). Parenting style may have an overarching effect on adolescents' EBRBs. The purpose of this study was to inform improvements to the design of intervention programs for the parents of adolescents by examining influences of parenting styles on adolescents' EBRBs. The current study used data from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study, which was an online survey on factors affecting adolescents' EBRBs among a national sample of adolescent-parent dyads (n = 1521; aged 12-17). Adolescents reported parenting dimensions of responsiveness and demandingness as well as parenting practices related to fruit and vegetable intake, junk food and sugary drink intake, physical activity, and screen time. They also reported food intake frequencies and time spent in physical activity and sedentary behaviors. Moderation and mediation analyses found that the potential protective effect of junk food/sugary drink- and physical activity-related parenting practices were significant among non-authoritarian parents. In addition, parenting styles had significant associations with adolescents' EBRBs after adjusting for the mediation effects of corresponding parenting practices. These findings suggest that further research and intervention programs need to consider the potential influence of parenting styles on adolescents' EBRBs. Parenting skill education to improve the connection between parents and adolescents may enhance the effectiveness of healthy lifestyle interventions.
A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers. (Am J Public Health. Published online ahead of print November 13, 2014: e1-e9. doi:10.2105/AJPH.2014.302206).
The purpose of this review was to determine the degree to which physical activity interventions for Latin American populations reported on internal and external validity factors using the RE-AIM framework (reach & representativeness, effectiveness, adoption, implementation, maintenance). We systematically identified English (PubMed; EbscoHost) and Spanish (SCIELO; Biblioteca Virtual en Salud) language studies published between 2001 and 2012 that tested physical activity, exercise, or fitness promotion interventions in Latin American populations. Cross-sectional/descriptive studies, conducted in Brazil or Spain, published in Portuguese, not including a physical activity/fitness/exercise outcome, and with one time point assessment were excluded. We reviewed 192 abstracts and identified 46 studies that met the eligibility criteria (34 in English, 12 in Spanish). A validated 21-item RE-AIM abstraction tool was used to determine the quality of reporting across studies (0-7 = low, 8-14 = moderate, and 15-21 = high). The number of indicators reported ranged from 3-14 (mean = 8.1 +/- 2.6), with the majority of studies falling in the moderate quality reporting category. English and Spanish language articles did not differ on the number of indicators reported (8.1 vs. 8.3, respectively). However, Spanish articles reported more across reach indicators (62% vs. 43% of indicators), while English articles reported more across effectiveness indicators (69% vs 62%). Across RE-AIM dimensions, indicators for reach (48%), efficacy/effectiveness (67%), and implementation (41%) were reported more often than indicators of adoption (25%) and maintenance (10%). Few studies reported on the representativeness of participants, staff that delivered interventions, or the settings where interventions were adopted. Only 13% of the studies reported on quality of life and/or potential negative outcomes, 20% reported on intervention fidelity, and 11% on cost of implementation. Outcomes measured after six months of intervention, information on continued delivery and institutionalization of interventions, were also seldom reported. Regardless of language of publication, physical activity intervention research for Latin Americans should increase attention to and measurement of external validity and cost factors that are critical in the decision making process in practice settings and can increase the likelihood of translation into community or clinical practice.
Objective To investigate the effectiveness of a school based intervention to increase physical activity, reduce sedentary behaviour, and increase fruit and vegetable consumption in children.
Design Cluster randomised controlled trial.
Setting 60 primary schools in the south west of England.
Participants Primary school children who were in school year 4 (age 8-9 years) at recruitment and baseline assessment, in year 5 during the intervention, and at the end of year 5 (age 9-10) at follow-up assessment.
Intervention The Active for Life Year 5 (AFLY5) intervention consisted of teacher training, provision of lesson and child-parent interactive homework plans, all materials required for lessons and homework, and written materials for school newsletters and parents. The intervention was delivered when children were in school year 5 (age 9-10 years). Schools allocated to control received standard teaching.
Main outcome measures The pre-specified primary outcomes were accelerometer assessed minutes of moderate to vigorous physical activity per day, accelerometer assessed minutes of sedentary behaviour per day, and reported daily consumption of servings of fruit and vegetables.
Results 60 schools with more than 2221 children were recruited; valid data were available for fruit and vegetable consumption for 2121 children, for accelerometer assessed physical activity and sedentary behaviour for 1252 children, and for secondary outcomes for between 1825 and 2212 children for the main analyses. None of the three primary outcomes differed between children in schools allocated to the AFLY5 intervention and those allocated to the control group. The difference in means comparing the intervention group with the control group was –1.35 (95% confidence interval –5.29 to 2.59) minutes per day for moderate to vigorous physical activity, –0.11 (–9.71 to 9.49) minutes per day for sedentary behaviour, and 0.08 (–0.12 to 0.28) servings per day for fruit and vegetable consumption. The intervention was effective for three out of nine of the secondary outcomes after multiple testing was taken into account: self reported time spent in screen viewing at the weekend (–21 (–37 to –4) minutes per day), self reported servings of snacks per day (–0.22 (–0.38 to –0.05)), and servings of high energy drinks per day (–0.26 (–0.43 to –0.10)) were all reduced. Results from a series of sensitivity analyses testing different assumptions about missing data and from per protocol analyses produced similar results.
Conclusion The findings suggest that the AFLY5 school based intervention is not effective at increasing levels of physical activity, decreasing sedentary behaviour, and increasing fruit and vegetable consumption in primary school children. Change in these activities may require more intensive behavioural interventions with children or upstream interventions at the family and societal level, as well as at the school environment level. These findings have relevance for researchers, policy makers, public health practitioners, and doctors who are involved in health promotion, policy making, and commissioning services.
Trial registration Current Controlled Trials ISRCTN50133740.
Children in the United States are on a pathway to live shorter lives due to the increased prevalence of lifestyle factors associated with obesity. Intervention programs implemented to reduce this trend do not adequately address the importance of parental involvement. Therefore, the purpose of this study was to examine the effectiveness of a child-only (i.e., control) versus a child-plus-parent (i.e., experimental) nutritional education program in reducing risk factors associated with childhood obesity. Four risk factors associated with childhood obesity were examined: knowledge of nutrition, dietary behavior, physical activity behavior, and sense of self-efficacy. Participants (N = 176) were second and third grade low-income students from a school in the Western United States. A self-reported survey was conducted in the participants’ classrooms one week prior to the intervention (pretest) and one week after the intervention (posttest). Findings indicated that nutrition knowledge and self-reported dietary habits significantly improved in both control and experimental groups. Physical activity behaviors did not change from pretest to posttest for participants in either groups. However, parental education improved participant self-efficacy, where a child's willingness to ask their primary caregivers to buy fruits and vegetables increased significantly. Nutritional education within school programs positively impacts nutritional choices irrespective of parental input. Furthermore, programs designed to increase youth self-efficacy could play a role in attenuating childhood obesity and its attendant societal costs.
Purpose
– This study is based on previous research which suggests that the Dudes programme increases children's fruit and vegetable consumption for school-provided meals by assessing its effectiveness in increasing the provision and consumption of fruit and vegetables in home-provided meals.
Design/methodology/approach
– Two cohorts of children participated from six schools in the West Midlands in the UK, one receiving the Food Dudes intervention and a matched control group who did not receive any intervention. Participants were children aged four to seven years from six primary schools, three intervention ( n =123) and three control schools ( n =156). Parental provision and consumption of fruit and vegetables was assessed pre-intervention, then three and 12 months post-intervention. Consumption was measured across five consecutive days in each school using digital photography.
Findings
– No significant increases in parental provision or consumption were found at three or 12 months for children in the intervention schools, however, increases were evident for children in the control group.
Research limitations/implications
– Further development of the Food Dudes programme could develop ways of working with parents and children to increase awareness of what constitutes a healthy lunch.
Originality value
– This is the first independent evaluation to assess the influence of the Food Dudes programme on parental provision and children's consumption of lunchtime fruit and vegetables.
The Active For Life Year 5 (AFLY5) randomised controlled trial protocol was published in this journal in 2011. It provided a summary analysis plan. This publication is an update of that protocol and provides a detailed analysis plan.Update: This update provides a detailed analysis plan of the effectiveness and cost-effectiveness of the AFLY5 intervention. The plan includes details of how variables will be quality control checked and the criteria used to define derived variables. Details of four key analyses are provided: (a) effectiveness analysis 1 (the effect of the AFLY5 intervention on primary and secondary outcomes at the end of the school year in which the intervention is delivered); (b) mediation analyses (secondary analyses examining the extent to which any effects of the intervention are mediated via self-efficacy, parental support and knowledge, through which the intervention is theoretically believed to act); (c) effectiveness analysis 2 (the effect of the AFLY5 intervention on primary and secondary outcomes 12 months after the end of the intervention) and (d) cost effectiveness analysis (the cost-effectiveness of the AFLY5 intervention. The details include how the intention to treat and per-protocol analyses were defined and planned sensitivity analyses for dealing with missing data. A set of dummy tables are provided in Additional file 1.
This detailed analysis plan was written prior to any analyst having access to any data and was approved by the AFLY5 Trial Steering Committee. Its publication will ensure that analyses are in accordance with an a priori plan related to the trial objectives and not driven by knowledge of the data.Trial registration: ISRCTN50133740.
Background:
Consumption of non-core foods in childhood is associated with excessive weight gain in childhood. Parents play a vital role in establishing healthy diet behaviours in young children. The aim of this study was to assess the effectiveness of a telephone-based intervention in reducing child consumption of non-core foods, and to examine parent and home food environment mediators of change in child consumption.
Methods:
The 'Healthy Habits' trial utilised a clustered randomised controlled design.
Setting/participants:
Parents were recruited from 30 preschools (N=394 participants, mean age 35.2±5.6 years). Parents randomized to the intervention group received four telephone contacts and print materials. Parents allocated to the control condition receive generic print materials only. Non-core food consumption was assessed using a validated child dietary questionnaire at baseline, 2 and 6 months post recruitment in 2010.
Results:
The intervention was effective in reducing child consumption of non-core foods at 2 months (intention to treat analysis: z=-2.83, p<.01), however this effect was not maintained at 6 months. Structural equation modelling using 2 month data indicated that child access to non-core foods in the home and child feeding strategies mediated the effect of the intervention.
Conclusion:
The telephone-based intervention shows promise in improving short term dietary behaviour in preschool age children, however further development is needed to sustain the effect in the long-term.
Trial registration:
Australian Clinical Trials Registry: ACTRN12609000820202.
Abstract Background The family food environment is an important influence in the development of children’s dietary habits. Research suggests that influences of current dietary behaviour and behaviour change may differ. The aims of this paper were to: (1) investigate the association between the food environment at baseline and change in children’s saturated fat intake; and (2) to explore whether a change in the food environment was associated with a change in children’s saturated fat intake. Method Secondary analysis of a 12 week cluster randomised controlled trial in 133 4-13 year old children. Families were randomly allocated to parental education regarding changing to reduced-fat dairy foods or a comparison non-dietary behaviour. The interventions were family focused. Parents received education from a dietitian in 3x30minute sessions to facilitate behaviour change. Parents completed a comprehensive questionnaire capturing three domains of the food environment – Parent knowledge and attitudes; shaping practices; and behaviours and role modelling. Children’s dietary intake was assessed via multiple 24-hour recalls at baseline and week 12. Changes in the family food environment and primary outcome (saturated fat) were calculated. Hierarchical linear regression models were performed to explore the association between baseline and change in food environment constructs and change in saturated fat intake. Standardised Beta are presented (p
Background.Physical inactivity is a risk behavior for cardiovascular and other diseases. Schools can promote public health objectives by increasing physical activity among youth.Methods.The Child and Adolescent Trial for Cardiovascular Health (CATCH) was a multicenter, randomized trial to test the effectiveness of a cardiovascular health promotion program in 96 public schools in four states. A major component of CATCH was an innovative, health-related physical education (PE) program. For 2.5 years, randomly assigned schools received a standardized PE intervention, including curriculum, staff development, and follow-up.Results.Systematic analysis of 2,096 PE lessons indicated students engaged in more moderate-to-vigorous physical activity (MVPA) in intervention than in control schools (P= 0.002). MVPA during lessons in intervention schools increased from 37.4% at baseline to 51.9%, thereby meeting the established Year 2000 objective of 50%. Intervention children reported 12 more min of daily vigorous physical activity (P= 0.003) and ran 18.6 yards more than control children on a 9-min run test of fitness (P= 0.21).Conclusions:The implementation of a standardized curriculum and staff development program increased children's MVPA in existing school PE classes in four geographic and ethnically diverse communities. CATCH PE provides a tested model for improving physical education in American schools.
Low levels of physical activity, high levels of sedentary behaviour and low levels of fruit and vegetable consumption are common in children and are associated with adverse health outcomes. The aim of this paper is to describe the protocol for a cluster randomised controlled trial (RCT) designed to evaluate a school-based intervention that aims to increase levels of physical activity, decrease sedentary behaviour and increase consumption of fruit and vegetables in school children.
The Active for Life Year 5 (AFLY5) study is a school-based, cluster RCT that targets school children in Year 5 (age 9-10 years). All state junior/primary schools in the area covered by Bristol City and North Somerset Council are invited to participate; special schools are excluded. Eligible schools are randomised to one of two arms: intervention arm (receive the intervention 2011-2012) and control arm (receive the intervention after the final follow-up assessment, 2013-2014). The primary outcomes of the trial are levels of accelerometer assessed physical activity and sedentary behaviour and questionnaire assessed fruit and vegetable consumption. A number of secondary outcomes will also be measured, including body mass index, waist circumference and overweight/obesity. Outcomes will be assessed at baseline (prior to intervention when the children are in Year 4), at the end of intervention 'immediate follow-up' and '12 months long-term' follow-up. We will use random effects linear and logistic regression models to compare outcomes by randomised arm. The economic evaluation from a societal perspective will take the form of a cost consequence analysis. Data from focus groups and interviews with pupils, parents and teachers will be used to increase understanding of how the intervention has any effect and is integrated into normal school activity.
The results of the trial will provide information about the public health effectiveness of a school-based intervention aimed at improving levels of physical activity, sedentary behaviour and diet in children.
ISRCTN50133740.
A randomized school based trial sought to increase fruit and vegetable consumption among children using a multicomponent approach.
The intervention, conducted in 20 elementary schools in St. Paul, targeted a multiethnic group of children who were in the fourth grade in spring 1995 and the fifth grade in fall 1995. The intervention consisted of behavioral curricula in classrooms, parental involvement, school food service changes, and industry support and involvement. Lunchroom observations and 24-hour food recalls measured food consumption. Parent telephone surveys and a health behavior questionnaire measured psychosocial factors.
The intervention increased lunchtime fruit consumption and combined fruit and vegetable consumption, lunchtime vegetable consumption among girls, and daily fruit consumption as well as the proportion of total daily calories attributable to fruits and vegetables.
Multicomponent school-based programs can increase fruit and vegetable consumption among children. Greater involvement of parents and more attention to increasing vegetable consumption, especially among boys, remain challenges in future intervention research.
Dairy foods are nutrient rich but also a source of saturated fat in the diets of children.
We assessed effects on dietary intakes and health outcomes of changing dairy foods consumed by children from regular- to reduced-fat varieties.
This study was a 24-wk cluster randomized controlled trial in 93 families with 4-13-y-olds who were randomly allocated to parental education regarding changing to reduced-fat dairy foods (n = 76 children) or reducing screen time (n = 69 children). Study outcomes, which were measured at weeks 0, 12 (end of the intervention), and 24, included saturated fat, energy, and nutrient intakes; pentadecanoic acid and blood lipid concentrations; body mass index z score; and waist circumference. Multilevel analyses were used with adjustment for child- and family-level covariates.
There were no group differences in overall dairy intakes (-45 g dairy; 95% CI: -141, 51 g dairy; P = 0.356). Saturated fat intakes were 3.3 percentage points lower (P < 0.0001) in the intervention group at week 24 than in the comparison group. Pentadecanoic acid concentrations were lower at week 12 (0.03%; P = 0.012) but not at week 24. LDL-cholesterol concentrations were not different at week 12, but LDL-cholesterol concentration was 0.15 mmol/L lower in the intervention group at week 24 than in the comparison group (P = 0.037). There were no significant group differences in total energy or adiposity measures. Regular-fat dairy foods decreased from 88% to 14% of dairy intake in the intervention group. Calcium, magnesium, and carbohydrate (percentage of energy) intakes were higher in the intervention group than in the comparison group; retinol intakes were lower in the intervention group than in the comparison group; and overall vitamin A intakes were similar between groups.
Advice to parents to change to reduced-fat products was effective in reducing children's saturated fat intakes but did not alter energy intakes or measures of adiposity. This trial was registered in the Australia New Zealand Clinical Trials Registry as ACTRN12609000453280.
Interventions that aim to improve child dietary quality and reduce disease risk often involve parents. The most effective methods to engage parents remain unclear. A systematic review of interventions designed to change child and adolescent dietary behavior was conducted to answer whether parent involvement enhanced intervention effectiveness, and what type of involvement was most effective in achieving desired outcomes.
In 2008, Pub Med, Medline, Psych Info, and Cochrane Library databases were searched to identify programs designed to change child and adolescent dietary intake that also involved parents. Methods of parental involvement were categorized based on the type and intensity of parental involvement. These methods were compared against intervention design, dietary outcomes, and quality of reporting (evaluated using CONSORT checklist) for each study.
The literature search identified 1774 articles and 24 met review criteria. Four studies systematically evaluated parent involvement with inconsistent results. Indirect methods to engage parents were most commonly used, although direct approaches were more likely to result in positive outcomes. Four studies met >70% of CONSORT items.
Limited conclusions may be drawn regarding the best method to involve parents in changing child diet to promote health. However, direct methods show promise and warrant further research.
To assess the short-term (15-d) and long-term (12-month) effects of a school-based health and nutrition education intervention on diet, nutrition intake and BMI.
The 12-week teacher-implemented intervention in combination with seminars organized for parents was aimed at improving children's diet and nutrition knowledge. The intervention took place between September 2007 and January 2008. The participants were randomized to two study groups, the intervention group (IG) and control group (CG), and were examined prior to the intervention on a variety of health knowledge, dietary, behavioural and anthropometric indices. The same measurements were collected 15 d and 1 year after the intervention.
All high schools in Vyronas, a densely populated district of Athens, Greece.
The sample consisted of 191 students aged 12-13 years.
Twelve months after the intervention, the programme was effective in reducing various indices in the IG compared with baseline findings (BMI: 23.3 (sd 2.8) v. 24.0 (sd 3.1) kg/m2, P < 0.001; daily energy intake: 8112.4 (sd 1412.4) v. 8503.3 (sd 1419.3) kJ/d, P < 0.001; total fat intake: 31.3 (sd 4.4) v. 35.4 (sd 4.7) % of daily energy, P < 0.001). Except for BMI, decreases in the aforementioned indices were also observed 15 d after the intervention. In addition, students of the IG reduced their weekly consumption of red meat and non-home-made meals and increased their frequency of fruit and breakfast cereal consumption.
The beneficial effects of this nutrition education intervention among adolescents may highlight the potential of such programmes in the prevention of obesity.
Family-school collaboration related to children's physical development has become increasingly important as childhood obesity rates continue to rise. The present study described the development and implementation of a literacy-based, family component of a school-based health education program and investigated its viability, acceptability, and effectiveness. Interactive children's books were the mechanism by which students, parents, and teachers received consistent messages at home and school regarding nutrition information. The home-school intervention served to bridge home and school cultures in an urban population. Preliminary process evaluation results indicated that the interactive children's books were feasible to implement in the school context. Parents, children, and teachers had positive perceptions of the books. Parents who received the books demonstrated increased knowledge of 5 a Day, the primary nutrition message communicated in the program. Although not statistically significant, after the first and second years of intervention, parents in the experimental group reported that their children were eating 0.54 and 0.36 additional servings of fruit and vegetables per day compared with children in the control group. The program did not seem to impact the availability and accessibility of fruits and vegetables at home.
This study compares the efficacy of a school-based program to an equivalent home-based program with 2,250 third grade students in 31 urban schools in Minnesota in order to detect changes in dietary fat and sodium consumption. The school-based program, Hearty Heart and Friends, involved 15 sessions over five weeks in the third grade classrooms. The home-based program, the Home Team, involved a five-week correspondence course with the third graders, where parental involvement was necessary in order to complete the activities. Outcome measures included anthropometric, psychosocial and behavioral assessments at school, and dietary recall, food shelf inventories, and urinary sodium data collected in the students' homes. Participation rates for all aspects of the study were notably high. Eighty-six per cent of the parents participated in the Home Team and 71 per cent (nearly 1,000 families) completed the five-week course. Students in the school-based program had gained more knowledge at posttest than students in the home-based program or controls. Students in the home-based program, however, reported more behavior change, had reduced the total fat, saturated fat, and monounsaturated fat in their diets, and had more of the encouraged foods on their food shelves. The data converge to suggest the feasibility and importance of parental involvement for health behavior changes with children of this age.
A major assumption underlying youth health promotion has been that physiological risk factors track from childhood into adulthood. However, few studies have systematically examined how behaviors change during adolescence. This paper describes longitudinal tracking of adolescent health behaviors in two Minnesota Heart Health Program communities.
Beginning in sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline n = 2376). Self-reported data included smoking behavior, physical activity, and food preferences.
A progressive increase in the change to weekly smoking status was observed across the smoking status categories. As students began to experiment with smoking, they were more likely to either begin to be or remain regular smokers. Tracking of physical activity and food choice variables was also apparent. In nearly all the follow-up periods, the students identified at baseline as measuring high remained high, and those measuring low remained low.
These results indicate that there is evidence of early consolidation and tracking of physical activity, food preference, and smoking behavior. The early consolidation of health behaviors implies that interventions should begin prior to sixth grade, before behavioral patterns are resistant to change. The smoking results suggest that students are experiencing difficulty quitting smoking; thus, youth smoking cessation interventions are warranted.
To comprehend the results of a randomized, controlled trial (RCT), readers must understand its design, conduct, analysis, and interpretation. That goal can be achieved only through complete transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by using a checklist and flow diagram. The revised CONSORT statement presented in this paper incorporates new evidence and addresses some criticisms of the original statement. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, and Discussion. The revised checklist includes 22 items selected because empirical evidence indicates that not reporting the information is associated with biased estimates of treatment effect or because the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage of participants through an RCT. The revised flow diagram depicts information from four stages of a trial (enrollment, intervention allocation, follow-up, and analysis). The diagram explicitly includes the number of participants, for each intervention group, that are included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have performed an intention-to-treat analysis. In sum, the CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.
Adequate reporting of randomized, controlled trials (RCTs) is necessary to allow accurate critical appraisal of the validity and applicability of the results. The CONSORT (Consolidated Standards of Reporting Trials) Statement, a 22-item checklist and flow diagram, is intended to address this problem by improving the reporting of RCTs. However, some specific issues that apply to trials of nonpharmacologic treatments (for example, surgery, technical interventions, devices, rehabilitation, psychotherapy, and behavioral intervention) are not specifically addressed in the CONSORT Statement. Furthermore, considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement. Therefore, the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments. A consensus meeting of 33 experts was organized in Paris, France, in February 2006, to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments. The participants extended 11 items from the CONSORT Statement, added 1 item, and developed a modified flow diagram. To allow adequate understanding and implementation of the CONSORT extension, the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting. This extension, in conjunction with the main CONSORT Statement and other CONSORT extensions, should help to improve the reporting of RCTs performed in this field.
Objective.-To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease. Design.-A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994). Participants.-A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas. Intervention.-Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education. Main Outcome Measures.-At the school level, the two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. individual level secondary end points included psychosocial factors, recall measures of eating and physical activity patterns, and other physiologic measures. Results.-In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%)(P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed. Conclusion.-The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.
Objective.
—To assess the outcomes of health behavior interventions, focusing on the elementary school environment, classroom curricula, and home programs, for the primary prevention of cardiovascular disease.Design.
—A randomized, controlled field trial at four sites with 56 intervention and 40 control elementary schools. Outcomes were assessed using prerandomization measures (fall 1991) and follow-up measures (spring 1994).Participants.
—A total of 5106 initially third-grade students from ethnically diverse backgrounds in public schools located in California, Louisiana, Minnesota, and Texas.Intervention.
—Twenty-eight schools participated in a third-grade through fifth-grade intervention including school food service modifications, enhanced physical education (PE), and classroom health curricula. Twenty-eight additional schools received these components plus family education.Main Outcome Measures.
—At the school level, the two primary end points were changes in the fat content of food service lunch offerings and the amount of moderate-to-vigorous physical activity in the PE programs. At the level of the individual student, serum cholesterol change was the primary end point and was used for power calculations for the study. Individual level secondary end points included psychosocial factors, recall measures of eating and physical activity patterns, and other physiologic measures.Results.
—In intervention school lunches, the percentage of energy intake from fat fell significantly more (from 38.7% to 31.9%) than in control lunches (from 38.9% to 36.2%)(P<.001 ). The intensity of physical activity in PE classes during the Child and Adolescent Trial for Cardiovascular Health (CATCH) intervention increased significantly in the intervention schools compared with the control schools (P<.02). Self-reported daily energy intake from fat among students in the intervention schools was significantly reduced (from 32.7% to 30.3%) compared with that among students in the control schools (from 32.6% to 32.2%) (P<.001). Intervention students reported significantly more daily vigorous activity than controls (58.6 minutes vs 46.5 minutes; P<.003). Blood pressure, body size, and cholesterol measures did not differ significantly between treatment groups. No evidence of deleterious effects of this intervention on growth or development was observed.Conclusion.
—The CATCH intervention was able to modify the fat content of school lunches, increase moderate-to-vigorous physical activity in PE, and improve eating and physical activity behaviors in children during 3 school years.(JAMA. 1996;275:768-776)
Young adulthood is a high-risk life stage for weight gain. Evidence is needed to translate behavioural approaches into community practice to prevent weight gain in young adults. This systematic review assessed the effectiveness and reporting of external validity components in prevention interventions. The search was limited to randomized controlled trial (RCT) lifestyle interventions for the prevention of weight gain in young adults (18–35 years). Mean body weight and/or body mass index (BMI) change were the primary outcomes. External validity, quality assessment and risk of bias tools were applied to all studies. Twenty-one RCTs were identified through 14 major electronic databases. Over half of the studies were effective in the short term for significantly reducing body weight and/or BMI; however, few showed long-term maintenance. All studies lacked full reporting on external validity components. Description of the intervention components and participant attrition rates were reported by most studies. However, few studies reported the representativeness of participants, effectiveness of recruitment methods, process evaluation detail or costs. It is unclear from the information reported how to implement the interventions into community practice. Integrated reporting of intervention effectiveness and enhanced reporting of external validity components are needed for the translation and potential upscale of prevention strategies.
Background:
Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions.
Purpose:
The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.
Method:
Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method can be used to address D&I challenges.
Results:
The case studies feature relevant behavioral topical areas: chronic disease prevention, community violence prevention, and educational intervention. To emphasize consistency with D&I priorities, the discussion of the value of each method is framed around the elements of the established Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.
Conclusion:
Systems science methods can help researchers, public health decision makers, and program implementers to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity.
Objective:
This study evaluated whether a nutrition-education program in child-care centers improved children's at-home daily consumption of fruits and vegetables, at-home use of low-fat/fat-free milk, and other at-home dietary behaviors.
Materials and methods:
Twenty-four child-care centers serving low-income families were matched by region, type, and size, and then randomly assigned to either an intervention or control condition. In the 12 intervention centers, registered dietitian nutritionists provided nutrition education to children and parents separately during a 6- to 10-week period. They also held two training sessions for center staff, to educate them on healthy eating and physical activity policies at the centers, and distributed weekly parent newsletters that included activities and recipes. Parents (n=1,143) completed a mail or telephone survey at baseline and follow-up to report information on their child's fruit, vegetable, and milk consumption and other dietary behaviors at home. This study used general and generalized linear mixed models to evaluate program impacts, while accounting for the clustering of children within centers. This study included child age, child sex, household size, respondent race/ethnicity, respondent age, and respondent sex as covariates.
Results:
The program had a substantial impact on children's at-home daily consumption of vegetables and use of low-fat/fat-free milk. This study also found a significant increase in the frequency of child-initiated vegetable snacking, which might have contributed to the significant increase in vegetable consumption. The program did not have a significant impact on fruit consumption or parental offerings of fruits and vegetables, child-initiated fruit snacking, or child fruit consumption.
Conclusions:
This intervention in child-care settings that emphasized children, parents, and teachers significantly increased at-home vegetable and low-fat/fat-free milk consumption among low-income preschoolers.
Background
Fruit, juice, and vegetable (FJV) consumption among children is low. Innovative programs are needed to enable children to increase FJV intake. Psychoeducational multimedia permits the delivery of interventions as designed and capitalizes on known behavior change principles.