Barriers to and Facilitators of the Evaluation of Integrated Community-Wide Overweight Intervention Approaches: A Qualitative Case Study in Two Dutch Municipalities

Abstract

To prevent overweight and obesity the implementation of an integrated community-wide intervention approach (ICIA) is often advocated. Evaluation can enhance implementation of such an approach and demonstrate the extent of effectiveness. To be able to support professionals in the evaluation of ICIAs we studied barriers to and facilitators of ICIA evaluation. In this study ten professionals of two Dutch municipalities involved in the evaluation of an ICIA participated. We conducted semi-structured interviews (n = 12), observed programme meetings (n = 4) and carried out document analysis. Data were analyzed using a thematic content approach. We learned that evaluation is hampered when it is perceived as unfeasible due to limited time and budget, a lack of evaluation knowledge or a negative evaluation attitude. Other barriers are a poor understanding of the evaluation process and its added value to optimizing the programme. Sufficient communication between involved professionals on evaluation can facilitate evaluation, as does support for evaluation of ICIAs together with stakeholders at a strategic and tactical level. To stimulate the evaluation of ICIAs, we recommend supporting professionals in securing evaluation resources, providing tailored training and tools to enhance evaluation competences and stimulating strategic communication on evaluation.

Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity

“…More specifically, all the programmes scored moderately to low with regard to monitoring and evaluation, and a process evaluation was poor or not carried out. Poor evaluation or absence of process evaluation is commonly observed in integrated community-based approaches, while possible explanations include the lack of motivation, resources, time and knowledge [ 7 , 24 ]. Another observation through both tools was that the target group was not thoroughly assessed prior to designing the interventions.…”

“…These lifestyles are influenced by societal, cultural, economic, organizational and environmental conditions [ 1 – 5 ]. This implies the need for integrating multiple sectors and targeting multiple levels of influence of unhealthy dietary and physical activity habits simultaneously [ 1 , 5 – 7 ]. Therefore, a socio-ecological approach for interventions and programs has been proposed [ 5 , 6 , 8 , 9 ] which involves a range of factors that affect individual behaviour, reflected at the interpersonal, organisational, community and policy levels [ 3 , 6 , 8 , 9 ].…”

“…The many integrated community-wide approaches aiming to tackle and/or prevent childhood overweight and obesity across Europe share obstacles challenging their effectiveness. The lack of effectiveness could also be attributed to unsuitable evaluation and monitoring methods, unable to identify crucial elements of success or failure, yet difficult to determine in complex programmes [ 7 , 20 , 21 ]. A systematic appraisal of the programmes’ strengths and weaknesses – namely, a detailed assessment of the steps involved and the elements that affect the various process during programme planning and implementation – would potentially enhance understanding of important programme components to be improved or to be paradigmatic.…”

Dynamics of Implementation and Maintenance of Organizational Health Interventions

“…The economic impacts associated with the obesity epidemic include medical, productivity, transportation, and human capital costs, which makes obesity-linked costs a noticeable portion of total national health expenditures [ 7 , 8 ]. Complexity of organizational health interventions : Social systems are complex and implementing health related interventions within organizations is specifically complex [ 9 , 10 ]. Such interventions require changes in work processes that are often in a complex zone where uncertainty and lack of agreement are common [ 11 ].…”

“…Complexity of organizational health interventions : Social systems are complex and implementing health related interventions within organizations is specifically complex [ 9 , 10 ]. Such interventions require changes in work processes that are often in a complex zone where uncertainty and lack of agreement are common [ 11 ].…”