Abstract
BackgroundThis systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.MethodsElectronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study’s intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.ResultsThirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.ConclusionsAlthough most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.Electronic supplementary materialThe online version of this article (doi:10.1186/s12966-014-0147-3) contains supplementary material, which is available to authorized users.
Highlights
This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework
Overweight and obesity contribute to mortality and the burden of many chronic diseases, such as cardiovascular diseases, cancer, type 2 diabetes and osteoarthritis [1,2,3,4]
Concerning the report of RE-AIM dimensions, the results showed that information was largely underreported, Figure 2 Performance of 10,000 Flanders, Body and Soul, Walk Kansas and Health-e-ame on individual RE-AIM dimensions
Summary
This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. The growing prevalence of overweight (Body Mass Index ≥25 kg/m2) and obesity (Body Mass Index ≥30 kg/m2) in adults is a major public health concern in European countries. Depending on country and gender, the overall prevalence of overweight in Europe currently ranges from 39.3% (France) to 64.9% (England) in men and from 21.9% (Italy) to 51.4% (England) in women. The overall prevalence of obesity ranges from 6.0% (France) to 21.6% (England) in men and from 5.0% (Italy) to 23.3% (England) in women [5]. In several European countries, adult obesity rates have doubled during the last two decades [6,7,8]. Given the serious health consequences and the rapidly increased prevalence, the development and implementation of effective, sustainable overweight and obesity prevention approaches is imperative
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