Strengthening the rigour of population-wide, community-based obesity prevention evaluations

Wolfenden, Luke; Wiggers, John

doi:10.1017/s1368980012004958

Cited by 14 publications

(13 citation statements)

References 81 publications

(232 reference statements)

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“…Lack of effective governance mechanism to implement and monitor nutrition polices in Low and Middle Income Countries (LMICs) has been identified as an ongoing challenge in previous research [ 23 , 24 , 25 ]. The salt reduction research project was led by C-POND, a regional research organization working on NCDs.…”

Section: Discussionmentioning

confidence: 99%

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

et al. 2018

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This paper reports the process evaluation and costing of a national salt reduction intervention in Fiji. The population-wide intervention included engaging food industry to reduce salt in foods, strategic health communication and a hospital program. The evaluation showed a 1.4 g/day drop in salt intake from the 11.7 g/day at baseline; however, this was not statistically significant. To better understand intervention implementation, we collated data to assess intervention fidelity, reach, context and costs. Government and management changes affected intervention implementation, meaning fidelity was relatively low. There was no active mechanism for ensuring food companies adhered to the voluntary salt reduction targets. Communication activities had wide reach but most activities were one-off, meaning the overall dose was low and impact on behavior limited. Intervention costs were moderate (FJD $277,410 or $0.31 per person) but the strategy relied on multi-sector action which was not fully operationalised. The cyclone also delayed monitoring and likely impacted the results. However, 73% of people surveyed had heard about the campaign and salt reduction policies have been mainstreamed into government programs. Longer-term monitoring of salt intake is planned through future surveys and lessons from this process evaluation will be used to inform future strategies in the Pacific Islands and globally.

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Section: Discussionmentioning

confidence: 99%

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

et al. 2018

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“…In order to move beyond this impasse, alternative research designs may be required to evaluate multifaceted approaches that function within a complex adaptive system (29,33,(44)(45)(46)(47). Signs of this are starting to emerge.…”

Section: Summary Of Resultsmentioning

confidence: 99%

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Nobles

Summerbell

Brown

et al. 2020

Preprint

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Background: Over the last 25 years, we have made great advances in our understanding of the complex adaptive systems which drive childhood obesity. Within this, the important role of upstream interventions which focus on the wider determinants of health (WDoH) has been acknowledged. Concurrently, the number of intervention studies aiming to prevent childhood obesity has increased exponentially. One might anticipate that our understanding of theory has been embedded into the development and implementation of interventions in real time. Methods: We tested this hypothesis by conducting secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 randomised controlled trials (RCTs) were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings in contrast to 226 perceived causes of obesity. Results: We found that the proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years). Conclusions: This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which takes a WDoH lens.

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“…For example, when support to implement policy or evidence-based programs cannot feasibly be provided to all sites or providers across the region simultaneously, research designs using a delayed or waitlist comparison group including stepped wedged (multiple baseline designs) or serial randomized controlled trial designs are used. Such designs maximize internal validity while remaining consistent with the required large-scale ''rollout'' of service delivery initiatives and address the ethical imperative of equitable access to health services [38]. For example, serial randomized trials have been used to evaluate an implementation strategy to support primary schools implement an evidence-based government policy to remove unhealthy foods from regular sale at schools canteens [39,40].…”

Section: Trials Of Strategies To Improve Implementation Of Evidence-bmentioning

confidence: 99%

Embedding researchers in health service organizations improves research translation and health service performance: the Australian Hunter New England Population Health example

Wolfenden

Yoong

Williams

et al. 2017

Journal of Clinical Epidemiology

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Strengthening the rigour of population-wide, community-based obesity prevention evaluations

Cited by 14 publications

References 81 publications

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

Process Evaluation and Costing of a Multifaceted Population-Wide Intervention to Reduce Salt Consumption in Fiji

A Secondary Analysis of the Childhood Obesity Prevention Literature through a Wider Determinants of Health Lens: Implications for Research Funders, Researchers, Policymakers and Practitioners

Embedding researchers in health service organizations improves research translation and health service performance: the Australian Hunter New England Population Health example

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