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21 pages, 492 KiB

Open AccessArticle

Dimensions of the Complexity of Health Interventions: What Are We Talking about? A Review

by Justine Trompette, Joëlle Kivits, Laetitia Minary and François Alla

Int. J. Environ. Res. Public Health 2020, 17(9), 3069; https://doi.org/10.3390/ijerph17093069 - 28 Apr 2020

Cited by 12 | Viewed by 3619

Abstract

Many recommendations and innovative approaches are available for the development and evaluation of complex health interventions. We investigated the dimensions of complexity described in health research and how these descriptions may affect the adopted research methodology (e.g., the choice of designs and methods). [...] Read more.

Many recommendations and innovative approaches are available for the development and evaluation of complex health interventions. We investigated the dimensions of complexity described in health research and how these descriptions may affect the adopted research methodology (e.g., the choice of designs and methods). We used a mixed method approach to review the scientific literature evaluating complex interventions in the health field. Of 438 articles identified, 179 were subjected to descriptive analysis and 48 to content analysis. The three principal dimensions of complexity were: stakeholder characteristics, intervention multimodality and context. Recognition of such dimensions influenced the methodological choices made during evaluation of the interventions with their use of designs and methods, which aimed to address the complexity. We analysed not only how researchers view complexity but also the effects of such views on researcher practices. Our results highlight the need for clarification of what complexity means and to consider complexity when deciding how to evaluate research interventions. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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16 pages, 727 KiB

Open AccessArticle

“And Then He Got into the Wrong Group”: A Qualitative Study Exploring the Effects of Randomization in Recruitment to a Randomized Controlled Trial

by Birthe Andrea Lehmann, Lara Lindert, Silke Ohlmeier, Lara Schlomann, Holger Pfaff and Kyung-Eun Choi

Int. J. Environ. Res. Public Health 2020, 17(6), 1886; https://doi.org/10.3390/ijerph17061886 - 14 Mar 2020

Cited by 8 | Viewed by 3388

Abstract

Background: Randomized controlled trials (RCTs) are regarded as the most internally valid means of estimating the effectiveness of complex public health interventions, but the recruitment of participants can be difficult. The aim of this study was to explore factors that may have affected [...] Read more.

Background: Randomized controlled trials (RCTs) are regarded as the most internally valid means of estimating the effectiveness of complex public health interventions, but the recruitment of participants can be difficult. The aim of this study was to explore factors that may have affected the recruitment of employees with musculoskeletal disorders (MSDs) to a multicenter worksite health promotion program from the perspective of recruiting case managers. Methods: Factors in recruitment to the RCT were explored using three focus group discussions with case managers. Data were processed using MAXQDA and analyzed with a combination of content and sequence analysis. Results: Findings showed that randomization is a major challenge for recruitment. Case managers adapted their communication with, and approaches to possible participants because of the randomization design and employed coping strategies to compensate for allocation into the control arm of the study. Perceptions of the superiority of the intervention group over the control group, perceptions of the (mis)match of participants to one of the groups, as well as the understanding of the necessity of randomization for effectiveness evaluations, further affected recruitment. Perceived expectations of possible participants and their (emotional) reactions to the randomization allocation also complicated recruitment. Conclusion: We were able to gain insight into the challenges of randomization for the recruitment of participants to a multicenter RCT. This study assisted the development of strategies to overcome barriers in the ongoing implementation process of the trial (i.e., the adaption of best practice information sheets and newsletters). There remains a need to develop effective interventions to help those recruiting to trials. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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18 pages, 4428 KiB

Open AccessArticle

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

by Sacha R.B. Verjans-Janssen, Sanne M.P.L. Gerards, Anke H. Verhees, Stef P.J. Kremers, Steven B. Vos, Maria W.J. Jansen and Dave H.H. Van Kann

Int. J. Environ. Res. Public Health 2020, 17(3), 751; https://doi.org/10.3390/ijerph17030751 - 24 Jan 2020

Cited by 10 | Viewed by 3984

Abstract

School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of “one size fits all” interventions. However, interventions that allow for local adaptation are more appropriate and [...] Read more.

School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of “one size fits all” interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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25 pages, 403 KiB

Open AccessArticle

Cognitive-Affective Change Mechanisms in Personalized Normative Feedback via the Articulated Thoughts in Simulated Situations Paradigm

by Justin F. Hummer, Melissa R. Hatch and Gerald C. Davison

Int. J. Environ. Res. Public Health 2020, 17(3), 690; https://doi.org/10.3390/ijerph17030690 - 21 Jan 2020

Cited by 5 | Viewed by 2721

Abstract

The research explored explanatory mechanisms of change for a personalized normative feedback (PNF) intervention, through an adapted application of the Articulated Thoughts in Simulated Situation (ATSS) cognitive think-aloud paradigm. A sample of 70 (51% female) U.S. adjudicated students were randomly assigned to one [...] Read more.

The research explored explanatory mechanisms of change for a personalized normative feedback (PNF) intervention, through an adapted application of the Articulated Thoughts in Simulated Situation (ATSS) cognitive think-aloud paradigm. A sample of 70 (51% female) U.S. adjudicated students were randomly assigned to one of three conditions: a PNF-ATSS condition, a PNF-Only condition (without ATSS), and an active Control+ATSS condition which received psychoeducation about alcohol use. Students in both the PNF-Only and PNF-ATSS conditions reported significant reductions in their misperceived peer drinking norms and alcohol-related consequences at the 30-day follow-up, relative to students in the control condition. Participants in the PNF-ATSS condition drank significantly fewer drinks per week at follow-up than participants in the PNF-Only condition, but not less than participants in the control condition. Significant indirect effects were found for the ATSS codes of participants’ neutrality and believability toward PNF content. This study presents a proof of concept for an adapted ATSS think-aloud methodology as a clinical science intervention tool to specify the cognitive-affective processes of change linked to complex intervention for particular problems, persons, and contexts. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

32 pages, 893 KiB

Open AccessArticle

Scale-Up and Scale-Out of a Gender-Sensitized Weight Management and Healthy Living Program Delivered to Overweight Men via Professional Sports Clubs: The Wider Implementation of Football Fans in Training (FFIT)

by Kate Hunt, Sally Wyke, Christopher Bunn, Craig Donnachie, Nicky Reid and Cindy M. Gray

Int. J. Environ. Res. Public Health 2020, 17(2), 584; https://doi.org/10.3390/ijerph17020584 - 16 Jan 2020

Cited by 38 | Viewed by 7373

Abstract

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that [...] Read more.

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs that can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs that are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents: the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries; and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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17 pages, 1561 KiB

Open AccessArticle

Exploring Mechanisms of Action: Using a Testing Typology to Understand Intervention Performance in an HIV Self-Testing RCT in England and Wales

by T. Charles Witzel, Peter Weatherburn, Adam Bourne, Alison J. Rodger, Chris Bonell, Mitzy Gafos, Roy Trevelion, Andrew Speakman, Fiona Lampe, Denise Ward, David T. Dunn, Michelle M. Gabriel, Leanne McCabe, Justin Harbottle, Yolanda Collaco Moraes, Susan Michie, Andrew N. Phillips, Sheena McCormack and Fiona M. Burns

Int. J. Environ. Res. Public Health 2020, 17(2), 466; https://doi.org/10.3390/ijerph17020466 - 10 Jan 2020

Cited by 12 | Viewed by 5170

Abstract

SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans [...] Read more.

SELPHI involves two interventions: A provides one HIV self-testing (HIVST) kit; B offers 3-monthly repeat HIVST kits if participants report ongoing risk. A logic model underpinned by the Behaviour Change Wheel informed the design of the intervention. SELPHI recruited 10,135 cis-men and trans people in England and Wales, all reporting anal sex with a man. This paper explores how the interventions were experienced and the mechanisms of action leading to impact for different groups of trial participants. In-depth interviews with 37 cis-men who have sex with men (MSM) were used to inductively categorise participants based on sexual and HIV testing histories. Themes relating to intervention experiences and impacts were mapped onto SELPHI-hypothesised intermediate outcomes to consider intervention impacts. Three groups were identified: ‘inexperienced testers’ engaged with SELPHI to overcome motivational and social and physical opportunity testing barriers. For ‘pro self-testers’, testing frequency was constrained by psychological and social barriers and lack of opportunity. ‘Opportunistic adopters’ engaged in HIVST for novelty and convenience. Perceived impacts for inexperienced testers were most closely aligned with the logic model, but for opportunistic adopters there was little evidence of impact. Distinctive groups were discernible with divergent intervention experiences. Using COM-B as a model for understanding behaviour change in relation to HIVST, our results indicate how HIVST interventions could be adapted to respond to different needs based on the target population’s demographic and behavioural features. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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15 pages, 300 KiB

Open AccessArticle

A Community-Based Participatory Approach to the Development and Implementation of an HIV Health Behavior Intervention: Lessons Learned in Navigating Research and Practice Systems from Project HAPPY

by Rhonda C. Holliday, Romell Phillips and Tabia Henry Akintobi

Int. J. Environ. Res. Public Health 2020, 17(2), 399; https://doi.org/10.3390/ijerph17020399 - 8 Jan 2020

Cited by 12 | Viewed by 4966

Abstract

African American young adults continue to be disproportionately affected by HIV/AIDS. The Southern United States has been particularly affected by HIV/AIDS, accounting for 52% of the new HIV diagnoses. Efforts to reduce the burden of HIV among young African Americans are still needed. [...] Read more.

African American young adults continue to be disproportionately affected by HIV/AIDS. The Southern United States has been particularly affected by HIV/AIDS, accounting for 52% of the new HIV diagnoses. Efforts to reduce the burden of HIV among young African Americans are still needed. Project HAPPY (HIV/AIDS Prevention Project for Youth) was developed and implemented using a community-based participatory research (CBPR) model. There were several challenges that arose during implementation of Project HAPPY that included recruitment, partner engagement, and retention. The realities of implementing an HIV prevention project with urban adolescents is discussed in detail and strategies to overcome these challenges, using a CBPR approach are described. The lessons learned from CBPR implementation of Project HAPPY include: (1) Create a feedback loop to receive community input and guidance throughout the life of the project; (2) Periodic community inventory to determine who is providing similar services to avoid saturation; (3) Prepare for Alternative Partner Engagement; (4) Consult (formally and informally) with the Institutional Review Board prior to submitting proposed changes to avoid unnecessary delays in implementation; (5) Select meaningful incentives for your priority population; and (6) Maintain multiple points of contact with community partners to mitigate the effects of staff turnover. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

13 pages, 842 KiB

Open AccessArticle

Complexity and Community Context: Learning from the Evaluation Design of a National Community Empowerment Programme

by Jane South, Daniel Button, Annie Quick, Anne-Marie Bagnall, Joanne Trigwell, Jenny Woodward, Susan Coan and Kris Southby

Int. J. Environ. Res. Public Health 2020, 17(1), 91; https://doi.org/10.3390/ijerph17010091 - 21 Dec 2019

Cited by 15 | Viewed by 4496

Abstract

Community empowerment interventions, which aim to build greater individual and community control over health, are shaped by the community systems in which they are implemented. Drawing on complex systems thinking in public health research, this paper discusses the evaluation approach used for a [...] Read more.

Community empowerment interventions, which aim to build greater individual and community control over health, are shaped by the community systems in which they are implemented. Drawing on complex systems thinking in public health research, this paper discusses the evaluation approach used for a UK community empowerment programme focused on disadvantaged neighbourhoods. It explores design choices and the tension between the overall enquiry questions, which were based on a programme theory of change, and the varied dynamic socio-cultural contexts in intervention communities. The paper concludes that the complexity of community systems needs to be accounted for through in-depth case studies that incorporate community perspectives. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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16 pages, 478 KiB

Open AccessArticle

Evaluation of Store Environment Changes of an In-Store Intervention to Promote Fruits and Vegetables in Latino/Hispanic-Focused Food Stores

by Jennifer Sanchez-Flack, Barbara Baquero, Shih-Fan Lin, George Belch, Julie L. Pickrel, Cheryl A. M. Anderson, Elva Arredondo, Maria Elena Martinez, Joni Mayer, Ming Ji, John P. Elder and Guadalupe X. Ayala

Int. J. Environ. Res. Public Health 2020, 17(1), 65; https://doi.org/10.3390/ijerph17010065 - 20 Dec 2019

Cited by 7 | Viewed by 4175

Abstract

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores ( [...] Read more.

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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15 pages, 308 KiB

Open AccessArticle

Co-Designing an Intervention to Prevent Overweight and Obesity among Young Children and Their Families in a Disadvantaged Municipality: Methodological Barriers and Potentials

by Didde Hoeeg, Ulla Christensen and Dan Grabowski

Int. J. Environ. Res. Public Health 2019, 16(24), 5110; https://doi.org/10.3390/ijerph16245110 - 14 Dec 2019

Cited by 10 | Viewed by 4343

Abstract

Design-based research (DBR) is an innovative methodology for co-creation, but potentials, challenges, and differences between methodological ideals and the real-life intervention context are under-researched. This study analyzes the DBR process in which researchers, professionals, and families co-design a family-based intervention to prevent childhood [...] Read more.

Design-based research (DBR) is an innovative methodology for co-creation, but potentials, challenges, and differences between methodological ideals and the real-life intervention context are under-researched. This study analyzes the DBR process in which researchers, professionals, and families co-design a family-based intervention to prevent childhood overweight and obesity in a rural municipality. It involves interviews with six key stakeholders in the co-design process. Data were coded and analyzed using systematic text condensation, while the theory of the “social effectiveness of interventions” developed by Rod et al. (2014) was used as an analytical tool for unpacking the co-creation process and exploring methodological barriers and potentials. The DBR approach contributed with a feeling that everyone’s perspective was important, and the professionals got a new perspective on the families’ experiences with healthy living they did not previously consider. We also found that the iterative design process did not fully align with the organizational structures in the municipality or with the needs of stakeholders, leading to friction in the partnership. This study emphasizes the complexity of using an anti-hierarchical approach within a hierarchical context, and the importance of being aware of how the DBR approach shapes the partnership, as well as of how the social dynamics within the partnership shape the design process. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

13 pages, 601 KiB

Open AccessArticle

Progreso en Salud: Findings from Two Adapted Social Network HIV Risk Reduction Interventions for Latina Seasonal Workers

by Mariano Kanamori, Mario De La Rosa, Cho-Hee Shrader, Cesar Munayco, Susanne Doblecki-Lewis, Guillermo Prado, Steven Safren, Mary Jo Trepka and Kayo Fujimoto

Int. J. Environ. Res. Public Health 2019, 16(22), 4530; https://doi.org/10.3390/ijerph16224530 - 15 Nov 2019

Cited by 13 | Viewed by 3575

Abstract

Background: Miami-Dade County, where many Latina seasonal workers reside and work, has the highest incidence of the human immunodeficiency virus (HIV) in the US: a rate four times the national average. Despite this disproportionate risk for HIV, there are no HIV prevention interventions [...] Read more.

Background: Miami-Dade County, where many Latina seasonal workers reside and work, has the highest incidence of the human immunodeficiency virus (HIV) in the US: a rate four times the national average. Despite this disproportionate risk for HIV, there are no HIV prevention interventions that aim to decrease HIV among Latina seasonal workers. Methods: The PROGRESO EN SALUD study compared the outcomes of two interventions adapted to include a social network component (VOICES and HEALTHY). Recruitment used a social network respondent-driven sampling design in which each seed was asked to recruit three friends, and those friends were asked to recruit three friends, for a total of twenty groups of 13 friends. We collected data at baseline, and 6 months and 12 months post intervention completion. We used generalized estimating equation models, properly adjusted for non-independent contributions of both social network interventions, to estimate the effects. Gaussian family multivariate models were calculated, addressing exchangeable working correlations, including both individual-level and cluster-level covariates in these models. Results: A total of 261 Latina seasonal workers participated in either the HEALTHY or the VOICES intervention. There were significant changes over time in cognitive factors (HIV knowledge, condom use self-efficacy, and adequate knowledge of condom use), behavioral factors (condom use, female condom use, and HIV testing), and communication factors (talking with friends about HIV prevention and intention to negotiate safe sex with male partners). Discussion: This study supports the literature suggesting that interventions incorporating social networks can have positive effects on HIV prevention and treatment outcomes, including sustained benefits beyond study periods. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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17 pages, 2022 KiB

Open AccessArticle

Co-producing Progression Criteria for Feasibility Studies: A Partnership between Patient Contributors, Clinicians and Researchers

by Hannah M. L. Young, Samantha Goodliffe, Meeta Madhani, Kay Phelps, Emma Regen, Anthony Locke, James O. Burton, Sally J. Singh, Alice C. Smith and Simon Conroy

Int. J. Environ. Res. Public Health 2019, 16(19), 3756; https://doi.org/10.3390/ijerph16193756 - 6 Oct 2019

Cited by 24 | Viewed by 4715

Abstract

There is a lack of guidance for developing progression criteria (PC) within feasibility studies. We describe a process for co-producing PC for an ongoing feasibility study. Patient contributors, clinicians and researchers participated in discussions facilitated using the modified Nominal Group Technique (NGT). Stage [...] Read more.

There is a lack of guidance for developing progression criteria (PC) within feasibility studies. We describe a process for co-producing PC for an ongoing feasibility study. Patient contributors, clinicians and researchers participated in discussions facilitated using the modified Nominal Group Technique (NGT). Stage one involved individual discussion groups used to develop and rank PC for aspects of the trial key to feasibility. A second stage involving representatives from each of the individual groups then discussed and ranked these PC. The highest ranking PC became the criteria used. At each stage all members were provided with a brief education session to aid understanding and decision-making. Fifty members (15 (29%) patients, 13 (25%) researchers and 24 (46%) clinicians) were involved in eight initial groups, and eight (two (25%) patients, five (62%) clinicians, one (13%) researcher) in one final group. PC relating to eligibility, recruitment, intervention and outcome acceptability and loss to follow-up were co-produced. Groups highlighted numerous means of adapting intervention and trial procedures should ‘change’ criteria be met. Modified NGT enabled the equal inclusion of patients, clinician and researcher in the co-production of PC. The structure and processes provided a transparent mechanism for setting PC that could be replicated in other feasibility studies. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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11 pages, 490 KiB

Open AccessArticle

Evaluating the Reliability and Validity of the Children’s Vitality-Relaxation Scale

by Kyung-Sook Bang, Sungjae Kim, Kalevi M. Korpela, Min Kyung Song, Gumhee Lee and Yeseul Jeong

Int. J. Environ. Res. Public Health 2019, 16(18), 3369; https://doi.org/10.3390/ijerph16183369 - 12 Sep 2019

Cited by 1 | Viewed by 3360

Abstract

This study developed the Children’s Vitality-Relaxation Scale (CVRS) by revising the adult version of the Restoration Outcome Scale (ROS). The CVRS was translated and culturally adapted into Korean, and its reliability and validity were evaluated in a cross-sectional, descriptive design study. Data collected [...] Read more.

This study developed the Children’s Vitality-Relaxation Scale (CVRS) by revising the adult version of the Restoration Outcome Scale (ROS). The CVRS was translated and culturally adapted into Korean, and its reliability and validity were evaluated in a cross-sectional, descriptive design study. Data collected from 181 elementary school students in grades 4‒6 were used to test the validity and reliability of the CVRS. Exploratory factor analysis, Pearson’s correlation, known-groups comparison, and Cronbach’s alpha were used for analysis. The factor analysis indicated a two-factor structure, and all factor loadings were above 0.40. The CVRS was a seven-point Likert scale consisting of eight items, which were classified as “vitality” (four items) and “relaxation” (four items). The external construct validity with the PANAS, PSS, and SRI was acceptable. In the known-groups comparison, the CVRS score was significantly higher for boys than for girls, and the CVRS score for high-income students was higher than low-income students. The Cronbach’s α for the scale was 0.84 and ranged from 0.72–0.87 for the subscales. Results showed that the CVRS is a valid and reliable scale with acceptable psychometric characteristics in Korean children. The scale can be used to measure children’s affect in various settings. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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16 pages, 1925 KiB

Open AccessArticle

An Intervention to Improve Uptake of Referrals for Children with Ear Disease or Hearing Loss in Thyolo District, Malawi: Acceptability and Feasibility

by Antonia Baum, Wakisa Mulwafu, Mwanaisha Phiri, Sarah Polack and Tess Bright

Int. J. Environ. Res. Public Health 2019, 16(17), 3144; https://doi.org/10.3390/ijerph16173144 - 28 Aug 2019

Cited by 12 | Viewed by 3914

Abstract

(1) Introduction: Poor uptake of referral for ear and hearing services in Malawi has been demonstrated in previous research. A multi-component educational intervention was developed to address poor uptake. The aim of this study was to explore the feasibility and acceptability of [...] Read more.

(1) Introduction: Poor uptake of referral for ear and hearing services in Malawi has been demonstrated in previous research. A multi-component educational intervention was developed to address poor uptake. The aim of this study was to explore the feasibility and acceptability of the intervention. In addition, we aimed to provide a case study of an intervention development and feasibility testing process in preparation for a potential randomised trial. (2) Methods: The intervention included three components: (i) an information booklet; (ii) personalised counselling by a community health worker and an expert mother; (iii) a text message reminder. To assess feasibility, the counselling and information booklet were provided for caregivers of eligible children (<18 years) at ear and hearing outreach camps in Thyolo. Text message reminders were sent to caregivers after the camps. After 4 weeks, all caregivers were revisited and completed a structured questionnaire and a subset were interviewed in-depth. (3) Results: 30 children were recruited, and 53% took up the referral. Interviews found counselling with a booklet was acceptable. It provided motivation, enabled a two-way conversation, and helped dispel fear. It allowed information to be shared with social networks, initiating conversations about raising funds. The text message reminder was reported to be a valued prompt. Challenges to feasibility included low network coverage, and time needed for counselling. Residual barriers included the costs of transportation. The cost was £3.70/camp. (4) Conclusions: The study found that counselling with an information booklet was feasible and acceptable. The process of testing the feasibility of the intervention identified some adaptations to the intervention components and delivery which could be implemented before it is tested in a trial. This study highlighted the value of the feasibility testing process. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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19 pages, 765 KiB

Open AccessArticle

The Moderating Role of the School Context on the Effects of the Healthy Primary School of the Future

by Nina Bartelink, Patricia van Assema, Maria Jansen, Hans Savelberg and Stef Kremers

Int. J. Environ. Res. Public Health 2019, 16(13), 2432; https://doi.org/10.3390/ijerph16132432 - 9 Jul 2019

Cited by 15 | Viewed by 4369

Abstract

Background: The current study investigated the moderating role of the school context on the effects of a Dutch health promoting school initiative on children’s health and health behaviors. Methods: The study used a mixed-methods design. The school context (n = [...] Read more.

Background: The current study investigated the moderating role of the school context on the effects of a Dutch health promoting school initiative on children’s health and health behaviors. Methods: The study used a mixed-methods design. The school context (n = 4) was assessed by the characteristics of the school population, teacher’s health-promoting (HP) practices, implementers’ perceived barriers, school’s HP elements, and dominating organizational issues. Outcomes included objectively assessed BMI z-scores and physical activity (PA), and parent and child-reported dietary intake. Analyses included linear mixed models (four intervention schools versus four control schools), and qualitative comparisons between intervention schools with similar HP changes. Results: Effects on outcomes varied considerably across schools (e.g., range in effect size on light PA of 0.01–0.26). Potentially moderating contextual aspects were the child’s socioeconomic background and baseline health behaviors; practices and perceived barriers of employees; and organizational issues at a school level. Conclusions: Similar HP changes lead to different outcomes across schools due to differences in the school context. The adoption of a complex adaptive systems perspective contributes to a better understanding of the variation in effects and it can provide insight on which contextual aspects to focus on or intervene in to optimize the effects of HP initiatives. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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18 pages, 1197 KiB

Open AccessArticle

From Complex Interventions to Complex Systems: Using Social Network Analysis to Understand School Engagement with Health and Wellbeing

by Hannah J. Littlecott, Graham F. Moore, Hugh Colin Gallagher and Simon Murphy

Int. J. Environ. Res. Public Health 2019, 16(10), 1694; https://doi.org/10.3390/ijerph16101694 - 14 May 2019

Cited by 13 | Viewed by 5856

Abstract

Challenges in changing school system functioning to orient them towards health are commonly underestimated. Understanding the social interactions of school staff from a complex systems perspective may provide valuable insight into how system dynamics may impede or facilitate the promotion of health and [...] Read more.

Challenges in changing school system functioning to orient them towards health are commonly underestimated. Understanding the social interactions of school staff from a complex systems perspective may provide valuable insight into how system dynamics may impede or facilitate the promotion of health and wellbeing. Ego social network analysis was employed with wellbeing leads within four diverse case study schools to identify variability in embeddedness of health and wellbeing roles. This variation, as well as the broader context, was then explored through semi-structured qualitative interviews with school staff and a Healthy Schools Coordinator, sampled from the wellbeing leads’ ego-networks. Networks varied in terms of perceived importance and frequency of interactions, centrality, brokerage and cliques. Case study schools that showed higher engagement with health and wellbeing had highly organised, distributed leadership structures, dedicated wellbeing roles, senior leadership support and outside agencies embedded within school systems. Allocation of responsibility for wellbeing to a member of the senior leadership team alongside a distributed leadership approach may facilitate the reorientation of school systems towards health and wellbeing. Ego-network analysis to understand variance in complex school system starting points could be replicated on a larger scale and utilised to design complex interventions. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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16 pages, 825 KiB

Open AccessArticle

Understanding System-Level Intervention Points to Support School Food and Nutrition Policy Implementation in Nova Scotia, Canada

by Jessie-Lee D. McIsaac, Rebecca Spencer, Melissa Stewart, Tarra Penney, Sara Brushett and Sara F.L. Kirk

Int. J. Environ. Res. Public Health 2019, 16(5), 712; https://doi.org/10.3390/ijerph16050712 - 27 Feb 2019

Cited by 9 | Viewed by 5102

Abstract

Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Such policies can improve equitable access, resources, and supports for healthy eating. However, despite the potential impact of SFNPs, several implementation [...] Read more.

Supporting the implementation of school food and nutrition policies (SFNPs) is an international priority to encourage healthier eating among children and youth. Such policies can improve equitable access, resources, and supports for healthy eating. However, despite the potential impact of SFNPs, several implementation barriers have been reported. This study sought to examine the system-level intervention points within a school food system using a complex systems framework. We conducted semi-structured interviews with various stakeholders working to influence the school food system in Nova Scotia, Canada. We sought to understand their roles and experiences with the SFNP by applying the Intervention Level Framework (ILF), a novel, solutions-oriented approach to better understand how complex systems function. Participants (n = 33) included teachers, parents, cafeteria workers, public health staff and non-profit organizations. Interview transcripts were first coded, then themed and finally analyzed using the ILF, resulting in three intervention points within the school food system. These were defined as: (1) Actors and Elements, (2) System Regulation and Interconnections and (3) Purpose and Values. We concluded that understanding the interactions between these system levels and stakeholder roles can help to inform the development of relevant policy strategies that better support healthier school food environments in this jurisdiction. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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Open AccessReview

Effectiveness Studies in Health Promotion: A Review of the Methodological Quality of Studies Reporting Significant Effects on Physical Activity in Working Age Adults

by Kevin Rudolf, Lea A. L. Dejonghe, Ingo Froböse, Florian Lammer, Lisa-Marie Rückel, Jessica Tetz and Andrea Schaller

Int. J. Environ. Res. Public Health 2019, 16(5), 813; https://doi.org/10.3390/ijerph16050813 - 6 Mar 2019

Cited by 4 | Viewed by 3908

Abstract

The methodology of intervention studies on physical activity (PA) promotion is of great importance regarding evidence development in complex interventions. The aim of this review was to provide an overview of the methodological quality of those studies which reported statistically significant effects of [...] Read more.

The methodology of intervention studies on physical activity (PA) promotion is of great importance regarding evidence development in complex interventions. The aim of this review was to provide an overview of the methodological quality of those studies which reported statistically significant effects of interventions promoting PA. PUBMED was searched for reviews on PA promotion to identify studies reporting effective interventions with participants of working age (16–67 years). Selected reviews were screened and data from primary studies with effective interventions were extracted to assess methodological quality. Forty-six reviews with 600 primary studies were identified, of which 33 met the inclusion criteria. Twenty-one studies were conducted as randomized controlled trials, 13 included an intervention control group, 25 measured PA by questionnaire, and 13 included objective measurements. Information on used statistics was often scarce, and long-term follow-up measurements were frequently missing. The overall methodological quality was moderate for randomized studies and low for non-randomized studies; information on methods and results was often lacking. To overcome these methodological issues, standardized guidelines for reporting study results should be considered, not only when publishing results but also when designing studies. This review provides a solid foundation for the development of practical advice for planning application-oriented studies in PA promotion. Full article

(This article belongs to the Special Issue Complex Interventions for Public Health Improvement)

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