Intervention dose estimation in health promotion programmes: a framework and a tool. Application to the diet and physical activity promotion PRALIMAP trial

Legrand, Karine; Bonsergent, E.; Latarche, Clotilde; Empereur, Fabienne; Collin, Jean-François; Lecomte, Édith; Aptel, E.; Thilly, Nathalie; Briançon, Serge

doi:10.1186/1471-2288-12-146

Cited by 14 publications

(10 citation statements)

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“…The implications of these uncertainties were highlighted by a recent systematic review and metaregression that found that the dose of a behavioral intervention was unrelated to effect size on child weight outcomes [9]. The relationship between dose and weightrelated outcomes is unclear partially because of variability in how behavioral intervention dose is categorized and quantified [10,11]. The NIH Treatment Fidelity Framework distinguishes between "how an intervention was intended to be delivered" vs. "how well providers adhere to the intended treatment, including information about actual dose and content delivered" [12].…”

Section: Introductionmentioning

confidence: 99%

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

Heerman

Sommer

et al. 2020

BMC Public Health

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Background: Current recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how "dose delivered" was associated with body mass index z-score (BMI-Z) across 3 years of follow-up. Methods: Parent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face "intensive sessions" (90 min each) and 6.75 h over the next 9 months via 9 "maintenance phone calls" (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having "zero" dose. Results: Among 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B =-0.011; 95% CI [− 0.021, − 0.001]; p = 0.029) and maintenance calls (B =-0.015; 95% CI [− 0.026, − 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parentchild pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2-or 3-year follow-up. Conclusions: In a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-toface sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up. Clinical trial registration: The trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.

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Section: Introductionmentioning

confidence: 99%

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

Heerman

Sommer

et al. 2020

BMC Public Health

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“…For example, Wasik and colleagues [12] distinguish between implementation and intervention dose and further subdivide the latter into the amount of intervention intended, offered, and received. Legrand and colleagues [7] provide an equation to calculate dose that involves measuring delivery quantity and quality and participation quantity and quality. Finally, Cheadle and colleagues [13] introduce the concept of ‘population dose’ which is defined as a product of the reach of an intervention and the strength of the effect (estimated as the effect on each person reached by the intervention).…”

Section: Introductionmentioning

confidence: 99%

Variation in the operationalisation of dose in implementation of health promotion interventions: insights and recommendations from a scoping review

2019

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Background While ‘dose’ is broadly understood as the ‘amount’ of an intervention, there is considerable variation in how this concept is defined. How we conceptualise, and subsequently measure, the dose of interventions has important implications for understanding how interventions produce their effects and are subsequently resourced and scaled up. This paper aims to explore the degree to which dose is currently understood as a distinct and well-defined implementation concept outside of clinical settings. Methods We searched four databases (MEDLINE, PsycINFO, EBM Reviews and Global Health) to identify original research articles published between 2000 and 2015 on health promotion interventions that contained the word ‘dose’ or ‘dosage’ in the title, abstract or keywords. We identified 130 articles meeting inclusion criteria and extracted data on how dose/dosage was defined and operationalised, which we then synthesised to reveal key themes in the use of this concept across health promotion interventions. Results Dose was defined in a variety of ways, including in relation to the amount of intervention delivered and/or received, the level of participation in the intervention and, in some instances, the quality of intervention delivery. We also observed some conflation of concepts that are traditionally kept separate (such as fidelity) either as slippage or as part of composite measures (such as ‘intervention dose’). Discussion Dose is not a well-defined or consistently applied concept in evaluations of health promotion interventions. While current approaches to conceptualisation and measurement of dose are suitable for interventions in organisational settings, they are less well suited to policies delivered at a population level. Dose often accompanies a traditional monotonic linear view of causality (e.g. dose response) which may or may not fully represent the intervention’s theory of how change is brought about. Finally, we found dose and dosage to be used interchangeably. We recommend a distinction between these terms, with ‘dosage’ having the advantage of capturing change to amount ‘dispensed’ over time (in response to effects achieved). Dosage therefore acknowledges the inevitable dynamic and complexity of implementation. Electronic supplementary material The online version of this article (10.1186/s13012-019-0899-x) contains supplementary material, which is available to authorized users.

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“…Process data, including quantitative and qualitative measures of participation and intervention delivery, was intended for estimating an intervention dose [37] . In health promotion programs, particularly those conducted within the framework of controlled trials, the level to which interventions are implemented must be considered when interpreting outcomes.…”

Section: Methodsmentioning

confidence: 99%

Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis

Legrand

Lecomte

Langlois

et al. 2017

Contemporary Clinical Trials Communications

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BackgroundDespite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents.MethodsPRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs.Inclusion resultsThe written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced.DiscussionThe PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school.Trial registrationClinicalTrials.gov (NCT01688453).

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Intervention dose estimation in health promotion programmes: a framework and a tool. Application to the diet and physical activity promotion PRALIMAP trial

Cited by 14 publications

References 20 publications

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

Variation in the operationalisation of dose in implementation of health promotion interventions: insights and recommendations from a scoping review

Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis

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