Application of an Implementation Framework Using Mixed Methods in Preschool Settings

Research Findings. Application of mixed methods in a dissemination and implementation framework can give researchers a better understanding of the reach and delivery of early childhood obesity prevention programs in preschool settings, as well as potential facilitators and barriers related to implementation and sustainability. This study utilized a simultaneous, exploratory, mixed-methods design to investigate individual-, organizational-, and intervention-level factors that were related to the implementation and sustainability of policy, system, and environment (PSE) changes as part of a larger obesity prevention program in a randomly selected sample of preschool centers ( n = 20). Individual-level factors, and specifically the attitudes and skills of preschool providers, were identified in both the qualitative and quantitative data as important factors related to the sustainability of PSE changes ( r = .56, p < .01). Staff and leadership engagement and adaptability of the program were also identified as important factors related to the implementation and sustainability of PSE changes. Practice or Policy. These findings highlight the complexity of implementation success and suggest PSE obesity prevention interventions in preschool centers require the consideration of numerous, multilevel factors to ensure programming is impactful and sustained over time.

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Development of a Dissemination and Implementation Framework for an Early Childhood Obesity Prevention Program

Journal of Nutrition Education and Behavior ◽

10.1016/j.jneb.2020.08.012 ◽

2020 ◽

Vol 52 (12) ◽

pp. 1160-1165

Author(s):

Emily Bergling ◽

Charlotte Farewell ◽

Jini Puma

Keyword(s):

Early Childhood ◽

Childhood Obesity ◽

Obesity Prevention ◽

Prevention Program ◽

Dissemination And Implementation ◽

Childhood Obesity Prevention ◽

Implementation Framework ◽

Early Childhood Obesity ◽

Obesity Prevention Program

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Lessons on early childhood obesity prevention interventions from the Victorian Infant Program

Public Health Research & Practice ◽

10.17061/phrp2911904 ◽

2019 ◽

Vol 29 (1) ◽

Cited By ~ 1

Author(s):

Penelope Love ◽

Rachel Laws ◽

Kylie Hesketh ◽

Karen Campbell

Keyword(s):

Early Childhood ◽

Childhood Obesity ◽

Obesity Prevention ◽

Childhood Obesity Prevention ◽

Prevention Interventions ◽

Early Childhood Obesity ◽

Infant Program

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Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-020-01074-8 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Mahalakshmi Ekambareshwar ◽

Swathi Ekambareshwar ◽

Seema Mihrshahi ◽

Li Ming Wen ◽

Louise A. Baur ◽

...

Keyword(s):

Qualitative Research ◽

Early Childhood ◽

Childhood Obesity ◽

Process Evaluation ◽

Obesity Prevention ◽

Text Messages ◽

Risk Of Bias ◽

Childhood Obesity Prevention ◽

Prevention Interventions ◽

Early Childhood Obesity

Abstract Background Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders’ acceptability of interventions. Methods A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers’ behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. Results Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants’ perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. Conclusion There is limited reporting of stakeholders’ experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants’ acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. Trial registration PROSPERO registration: CRD42019108658

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Protocol for the development of Core Outcome Sets for Early intervention trials to Prevent Obesity in CHildren (COS-EPOCH)

BMJ Open ◽

10.1136/bmjopen-2020-048104 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048104

Author(s):

Vicki Brown ◽

Marj Moodie ◽

Huong Ngoc Quynh Tran ◽

Marufa Sultana ◽

Kylie Elizabeth Hunter ◽

...

Keyword(s):

Physical Activity ◽

Early Childhood ◽

Childhood Obesity ◽

Obesity Prevention ◽

Core Outcome ◽

Core Outcome Sets ◽

Key Stakeholders ◽

Core Outcomes ◽

Prevention Interventions ◽

Early Childhood Obesity

IntroductionChildhood overweight and obesity is prevalent in the first 5 years of life, and can result in significant health and economic consequences over the lifetime. The outcomes currently measured and reported in randomised controlled trials of early childhood obesity prevention interventions to reduce this burden of obesity are heterogeneous, and measured in a variety of ways. This variability limits the comparability of findings between studies, and contributes to research waste. This protocol presents the methodology for the development of two core outcome sets (COS) for obesity prevention interventions in children aged from 1 to 5 years from a singular development process: (1) a COS for interventions targeting physical activity and sedentary behaviour and (2) a COS for interventions targeting child feeding and dietary intake. Core outcomes related to physical activity and sedentary behaviour in children aged ≤1 year will also be identified to complement an existing COS for early feeding interventions, and provide a broader set of core outcomes in this age range. This will result in a suite of COS useful for measuring and reporting outcomes in early childhood obesity prevention studies, including multicomponent interventions.Methods and analysisDevelopment of the COS will follow international best practice guidelines. A scoping review of trial registries will identify commonly reported outcomes and associated measurement instruments. Key stakeholders involved in obesity prevention, including policy-makers/funders, parents, researchers, health practitioners and community and organisational stakeholders will participate in an e-Delphi study and consensus meeting regarding inclusion of outcomes in the COS. Finally, recommended outcome measure instruments will be identified through literature review and group consensus.Ethics and disseminationDeakin University Human Research Ethics Committee (HEAG-H 231_2020). The COS will be disseminated through peer-reviewed publications and engagement with key stakeholders.

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An exploration of constructs related to dissemination and implementation of an early childhood systems-level intervention

Health Education Research ◽

10.1093/her/cyaa038 ◽

2020 ◽

Vol 35 (6) ◽

pp. 574-583

Author(s):

Charlotte V Farewell ◽

Jini Puma ◽

Emily Bergling ◽

Julie Webb ◽

Jennie Quinlan ◽

...

Keyword(s):

Health Promotion ◽

Early Childhood ◽

Early Childhood Education ◽

Eating Behaviors ◽

Organizational Level ◽

Dissemination And Implementation ◽

Successful Implementation ◽

Implementation Framework ◽

Individual Level ◽

Childhood Education

Abstract Obesity and overweight in early childhood have detrimental impacts on children’s health and development. Changing policy, system and environmental features focused on physical activity and healthy eating behaviors as part of health promotion interventions can play a key role in prevention strategies in early childhood education settings. These types of changes can have broad reach and are often sustained over time, which allows for impact on children who enter the early childhood education setting year after year. However, there is currently a gap between the generation of evidence for health promotion programs and their application into practice. This study used qualitative methods to evaluate intervention-, organizational- and individual-level factors within a dissemination and implementation framework that may be related to the implementation of a health-promoting intervention in early childhood education settings. Intervention-level factors, including feasibility and adaptability, organizational-level factors, including staff and leadership engagement, and individual-level factors, including attitudes, skills and knowledge, were identified as constructs that impacted the successful implementation of the intervention. These findings provide insight into core dissemination and implementation constructs that should be targeted by obesity prevention interventions in early childhood education settings to ensure maximum impact on sustainable behavior change.

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Unpacking the behavioural components and delivery features of early childhood obesity prevention interventions in the TOPCHILD Collaboration: a systematic review and intervention coding protocol

10.1101/2020.12.17.20248435 ◽

2020 ◽

Author(s):

Brittany J Johnson ◽

Kylie E Hunter ◽

Rebecca K Golley ◽

Paul Chadwick ◽

Angie Barba ◽

...

Keyword(s):

Systematic Review ◽

Early Childhood ◽

Childhood Obesity ◽

Research Ethics ◽

Behaviour Change ◽

Obesity Prevention ◽

Ethics Committee ◽

Behaviour Change Techniques ◽

Prevention Interventions ◽

Early Childhood Obesity

ABSTRACTIntroductionLittle is known about how early (e.g., commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to 1) characterise early obesity prevention interventions in terms of target behaviours, delivery features, and behaviour change techniques (BCTs), 2) explore similarities and differences in BCTs used to target behaviours, and 3) explore effectiveness of intervention components in preventing childhood obesity.Methods and analysisAnnual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the TOPCHILD Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components.Ethics and disseminationThe study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study’s findings will be disseminated through peer-reviewed publications, conference presentations, and targeted communication with key stakeholders.DiscussionOur study will provide an in depth understanding of behavioural components and delivery features used in obesity prevention interventions starting antenatally or in the first 12 months after birth. Understanding common intervention approaches in a systematic way will provide much needed insight to advance the design of early obesity prevention interventions and provide the opportunity to undertake future quantitative predictive modelling.RegistrationPROSPERO registration no. CRD42020177408STRENGTHS AND LIMITATIONS OF THIS STUDYThis study provides an understanding of behaviours targeted, behaviour change techniques and delivery features used in early childhood obesity prevention trials identified in a systematic review as being eligible for inclusion in the Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration.Extends previous methods by coding behaviour change techniques in published and unpublished intervention materials and performing cross validation with trialists through the TOPCHILD Collaboration.Using standardised coding taxonomies will allow for comparisons across studies, and we will pilot test new ontologies from the Human Behaviour Change Project.Explores the complex area of targeting parent and caregivers’ behaviours to impact child outcomes across four key obesity prevention behavioural domains (relating to infant feeding practices, food provision and parent feeding practices, movement practices, sleep health practices).This study will provide preliminary results regarding the examination of intervention components’ effectiveness based on exploratory analysis. Yet, the internationally unique database this project creates will further our understanding of effective intervention components in future research.To date we already have 38 out of 65 eligible trials agreeing to share data, since not all trials may provide unpublished material we may perform sensitivity analyses comparing trials that have shared data to trials that have not shared materials.

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“My Tummy Tells Me” Cognitions, Barriers and Supports of Parents and School-Age Children for Appropriate Portion Sizes

Nutrients ◽

10.3390/nu10081040 ◽

2018 ◽

Vol 10 (8) ◽

pp. 1040 ◽

Cited By ~ 6

Author(s):

Kaitlyn Eck ◽

Colleen Delaney ◽

Miriam Leary ◽

Oluremi Famodou ◽

Melissa Olfert ◽

...

Keyword(s):

Obesity Prevention ◽

Weight Control ◽

Portion Size ◽

School Age Children ◽

School Age ◽

Healthy Weight ◽

Parents And Children ◽

Portion Sizes ◽

Prevention Interventions ◽

Obesity Prevention Programs

Larger portion sizes have increased in tandem with the rise in obesity. Elucidation of the cognitions of children and parents related to portion size is needed to inform the development of effective obesity prevention programs. This study examined cognitions of parents (n = 36) and their school-age children (6 to 11 years; n = 35) related to portion sizes via focus group discussions. Parents and children believed controlling portion sizes promoted health and weight control. Some parents felt controlling portions was unnecessary, particularly if kids were a healthy weight because kids can self-regulate intake. Barriers to serving appropriate portions identified by parents focused largely on kids getting enough, rather than too much, to eat. Parents also identified lack of knowledge of age-appropriate portions as a barrier. Facilitators of portion control cited by parents included purchasing pre-portioned products and using small containers to serve food. Children relied on cues from parents (e.g., amount of food parent served them) and internal hunger/satiety cues to regulate intake but found it difficult to avoid overeating highly palatable foods, at restaurants, and when others were overeating. Results suggest obesity prevention interventions should aim to improve portion sizes cognitions, barrier management, and use of facilitators, in families with school-age children.

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