A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia

Abstract

BackgroundThe prevalence of childhood obesity poses an urgent global challenge. The World Health Organization (WHO) Commission on Ending Childhood Obesity recommends the provision of appropriate family-based, lifestyle weight management services through universal health care to support families of children with overweight or obesity; however, there are few examples of their implementation ‘at scale’. The purpose of this research was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation.MethodsPurposeful stratified sampling was used to select health service study sites (n = 16) representative of program implementation (none, discontinued, repeated) and geographic location within each State. Within each health service site, staff involved in program delivery, co-ordination and management roles participated (n = 39). An additional 11 staff involved in implementation at State level also participated. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview scripts. Telephone interviews were recorded and transcribed. Transcripts were thematically coded and scored according to CFIR constructs and rating rules to identify enablers and barriers to implementation according to sample characteristics.ResultsNew South Wales achieved ongoing implementation; Queensland did not. Enablers included a quality evidence-based program, State government recognition of the urgency of the health issue and a commitment to address it, formally appointed and funded internal implementation leaders, strong communication and reporting at all levels. Barriers included the complexity of the health issue, in particular a lack of clear roles and responsibilities for local health service delivery, inadequate ongoing funding and challenges in meeting the diverse needs of families.ConclusionsThis research is an important progression of the evidence base in relation to the translation of childhood obesity management trials into routine health service delivery. Understanding enablers and barriers to program implementation ‘at scale’ is imperative to inform future planning and investment by Australia and WHO member states to meet their commitment to deliver childhood weight management services as part of universal health coverage.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0801-2) contains supplementary material, which is available to authorized users.

Understanding, comparing and learning from the four EPOCH early childhood obesity prevention interventions: A multi‐methods study

“…The importance of co‐design for effective health interventions has been documented previously, 38,39 and our findings support this. Collaboration and co‐design with existing stakeholders, health services and governments were pointed out throughout the interviews as key to the success of the EPOCH interventions and their translation efforts.…”

“…The present results add to the growing body of evidence examining factors that need to be considered when designing an intervention to be delivered at scale. Specifically, our findings align with previous research by emphasising the need to ensure that facilitators are appropriately trained, key messages are repeated throughout a program and delivery occurs across childhood to avoid fade‐out effects of health gains 37,38 . A key message from the interviews was the need to seamlessly align the intervention with other efforts to prevent childhood obesity.…”

Assessing scalability of an intervention: why, how and who?

“…In the research sphere, we found few studies that used the scalability tools identified in the peer-reviewed literature (Cambon et al , 2013; Milat et al , 2016) to consider the question of scalability of an intervention. Such studies were either retrospective case studies using the tool as an analytical framework (Trompette et al , 2014; Vidgen et al , 2018), or trial protocols proposing a qualitative implementation study or process evaluation focused on scale-up, running in parallel or at the end of the study (Kabore et al , 2016; Lonsdale et al , 2016). However, these are yet to generate evidence on the success of scaling-up strategies, as advocated by previous reviews (Ben Charif et al , 2017).…”

Input from multiple stakeholder levels prioritizes targets for improving implementation of an exercise intervention for rural women cancer survivors

“…Those standardized constructs provide an approach to articulate the determinants of implementation success and a guide to identify factors that are most important to implementation [ 30 ]. A body of qualitative and mixed-method studies have adopted CFIR to develop interview guides [ 32 ], form codebooks [ 33 ], analyze and interpret data [ 34 ], and report implementation-related findings [ 29 ]. These reports provide strong support for incorporating CFIR constructs when identifying multilevel factors that facilitate or hinder implementation, including the implementation of exercise programs for rural CSs [ 33 – 37 ].…”