Dynamics behind the scale up of evidence-based obesity prevention: protocol for a multi-site case study of an electronic implementation monitoring system in health promotion practice

Abstract

BackgroundThe effectiveness of many interventions to promote health and prevent disease has been well established. The imperative has therefore shifted from amassing evidence about efficacy to scale-up to maximise population-level health gains. Electronic implementation monitoring, or ‘e-monitoring’, systems have been designed to assist and track the delivery of preventive policies and programs. However, there is little evidence on whether e-monitoring systems improve the dissemination, adoption, and ongoing delivery of evidence-based preventive programs. Also, given considerable difficulties with e-monitoring systems in the clinical sector, scholars have called for a more sophisticated re-examination of e-monitoring’s role in enhancing implementation.MethodsIn the state of New South Wales (NSW), Australia, the Population Health Information Management System (PHIMS) was created to support the dissemination of obesity prevention programs to 6000 childcare centres and elementary schools across all 15 local health districts. We have established a three-way university-policymaker-practice research partnership to investigate the impact of PHIMS on practice, how PHIMS is used, and how achievement of key performance indicators of program adoption may be associated with local contextual factors. Our methods encompass ethnographic observation, key informant interviews and participatory workshops for data interpretation at a state and local level. We use an on-line social network analysis of the collaborative relationships across local health district health promotion teams to explore the relationship between PHIMS use and the organisational structure of practice.DiscussionInsights will be sensitised by institutional theory, practice theory and complex adaptive system thinking, among other theories which make sense of socio-technical action. Our working hypothesis is that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role they play in the on-going system of local relationships and multiple accountabilities. Data will be synthesised to produce a typology to characterise local context, PHIMS use and key performance indicator achievement (of program implementation) across the 15 local health districts. Results could be used to continuously align e-monitoring technologies within quality improvement processes to ensure that such technologies enhance practice and innovation. A partnership approach to knowledge production increases the likelihood that findings will be put into practice.

From demonstration project to changes in health systems for child obesity prevention: the legacy of ‘Good for Kids, Good for Life’

“…Intervention Management System (PHIMS). 4 The PHIMS uses policy and practice measurement items developed and validated by the GfK program 13 and provides feedback to LHDs on implementation progress. The data are also used at the state level to inform HCI quality improvement and innovation.…”

“…3,4 Rigorous controlled evaluations of the service delivery models provided evidence for 'how' community settings could be re-oriented to more effectively deliver obesity prevention services at scale. The program achieved high community awareness (60%) significant reach (e.g.…”

“…4 The PHIMS uses policy and practice measurement items developed and validated by the GfK program 13 and provides feedback to LHDs on implementation progress. Establishment of the Population Health Intervention Management System (PHIMS).…”

“…4 The ability to monitor implementation reach and outputs (via PHIMS) at the state level also meant NSW was more resilient when National Partnership Agreement on Preventive Health funding was withdrawn. 4 The ability to monitor implementation reach and outputs (via PHIMS) at the state level also meant NSW was more resilient when National Partnership Agreement on Preventive Health funding was withdrawn.…”

“…>80% of schools and childcare services), led to significant improvements in the adoption of policies and practices across community settings, improved student dietary intake and physical activity, and reduced population prevalence of child obesity by 1% per year against an otherwise increasing prevalence in the rest of the state. 3,4 Rigorous controlled evaluations of the service delivery models provided evidence for 'how' community settings could be re-oriented to more effectively deliver obesity prevention services at scale. These implementation trials were among the first of their kind and contributed an early and substantive body of evidence to an emerging field of implementation science in community settings.…”