Developing an index of dose of exposure to early childhood obesity community interventions

Abstract

The recognition of the role of the environment in contributing to the obesity epidemic has led to increasing efforts to address obesity through environmental or place-based approaches in the past decade. This has challenged the use of the quasi-experimental design for evaluating community interventions. The objective of this study is to describe the development of an index of dose of exposure to community interventions that impact early childhood obesity. The goal is to provide an alternative means for evaluating the impact of multiple intervention strategies that target the same community at the same time. Two workgroups developed domains, constructs and protocols for estimating a "community intervention dose index" (CIDI). Information used to develop the protocol came from multiple sources including databases and reports of major funding organizations on obesity-related interventions implemented in Los Angeles County from 2005 to 2015, key informant interviews, and published literature. The workgroups identified five domains relevant to the consideration of dose of exposure to interventions: physical resources, social resources, context, capacity development, and programs and policies; developed a system for classifying programs and policies into macro- and micro-level intervention strategies; and sought ratings of strategy effectiveness from a panel of 13 experts using the Delphi technique, to develop an algorithm for calculating CIDI that considers intervention strength, reach and fidelity. This CIDI can be estimated for each community and used to evaluate the impact of multiple programs that use a myriad of intervention strategies for addressing a defined health outcome.

Notes From the Field: Creating a Typology of Childhood Obesity Intervention Strategies

“…In Stage 3, synthesis of the information extracted from Stage 2 yielded four macrolevel and five microlevel intervention strategy categories for early childhood obesity intervention ( Figure 2): macrolevel: government policies, public institutional policies, infrastructure investments, and business practices and microlevel: group education, counseling, health communication and social marketing, home visitation, and body mass index screenings and referrals for weight management. Application of this typology has been described elsewhere (Wang et al, 2018).…”

“…The present typology was used to construct a community intervention dose index (CIDI) that could be applied to estimate the local impacts of implementing multiple strategies in combination and/or in sequence. Specifically, its application allowed for better analysis, interpretation, and understanding of program data from the NIH-funded Early Childhood and Obesity Systems Science Study (ECOSYS), which sought to assess the dose of exposure of priority populations to several local childhood obesity intervention strategies implemented in Los Angeles County (LAC) during 2000-2016 (Wang et al, 2018). To the best of our knowledge, the present study is the first of its kind to describe the development of a typology of childhood obesity strategy interventions.…”

Promoting congregant health in faith-based organizations across Los Angeles County, 2013–2016

“…It is possible that the interventions needed to change these outcomes require extended exposure time and/or higher doses of the interventions. For example, a recent research study on childhood obesity posits that the dose of exposure is critical; i.e., most PSEs likely will require an intervention or a group of interventions to reach a certain threshold/level of exposure before any improvement will be seen at the population-level (Wang et al, 2018).…”

Outcomes of a Community-Wide Health Intervention in a Low-Income, Primarily Hispanic Community: The Go! Austin/Vamos! Austin (GAVA) Initiative

“…The questions utilized in the survey were developed de novo for the project and for the study population and are weak in many cases. The exposure measure could be more sensitive if it involved more dimensions such as domain and effectiveness of strategy (Wang et al, 2018), but that was outside the scope of this study. Use of a 4-year pre-post interval allowed time for effects to be expressed; however, some fading of effects of early interventions could have occurred over this period.…”