Health professional-delivered obesity prevention interventions during the first 1,000 days: A systematic review of external validity reporting

Marita Hennessy,Elaine Toomey,Rachel Laws,Luke Van Rhoon,Hazel Wolstenholme,Molly Byrne,Caroline Heary

doi:10.12688/hrbopenres.12924.1

Abstract

Background: Childhood obesity prevention interventions delivered by health professionals during the first 1,000 days show some evidence of effectiveness, particularly in relation to behavioural outcomes. External validity refers to how generalisable interventions are to populations or settings beyond those in the original study. The degree to which external validity elements are reported in such studies is unclear however. This systematic review aimed to determine the extent to which childhood obesity interventions delivered by health professionals during the first 1,000 days report on elements that can be used to inform generalizability across settings and populations. Methods: Eligible studies meeting study inclusion and exclusion criteria were identified through a systematic review of 11 databases and three trial registers. An assessment tool based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to assess the external validity of included studies. It comprised five dimensions: reach and representativeness of individuals, reach and representativeness of settings, implementation and adaptation, outcomes for decision making maintenance and/or institutionalisation. Two authors independently assessed the external validity of 20% of included studies; discrepancies were resolved, and then one author completed assessments of the remaining studies. Results: In total, 39 trials involving 46 interventions published between 1999 and 2019 were identified. The majority of studies were randomized controlled trials (n=24). Reporting varied within and between dimensions. External validity elements that were poorly described included: representativeness of individuals and settings, treatment receipt, intervention mechanisms and moderators, cost effectiveness, and intervention sustainability and acceptability. Conclusions: Our review suggests that more emphasis is needed on research designs that consider generalisability, and the reporting of external validity elements in early life childhood obesity prevention interventions. Important gaps in external validity reporting were identified that could facilitate decisions around the translation and scale-up of interventions from research to practice. Registration: PROSPERO CRD42016050793 03/11/16.

Highlights

Effective, scalable, and affordable strategies that do not widen health inequities are needed to address childhood obesity[1,2]
This was echoed in a recent research prioritisation study in which ‘Implementation science’ and ‘How to integrate obesity prevention into existing service structures’ were the third and fourth ranked research priorities identified by researchers, policymakers and practitioners[5]
This study aims to determine the extent to which childhood obesity interventions delivered by health professionals during the first 1,000 days report on factors that can be used inform generalizability across settings and populations, and to provide recommendations for researchers planning to conduct similar studies

Summary

Introduction

Reviewer Comment 4: For the non-specialist reader, it might be useful to insert a paragraph at the start of the introduction to outline the current state of play in early childhood obesity prevention, e.g. explain current obesity prevalence when starting school, highlight the importance of obesity prevention interventions within infancy (and during pregnancy), and outline what these interventions typically involve. This systematic review aimed to determine the extent to which childhood obesity interventions delivered by health professionals during the first 1,000 days report on elements that can be used to inform generalizability across settings and populations. Conclusions: Our review suggests that more emphasis is needed on research designs that consider generalisability, and the reporting of external validity elements in early life childhood obesity prevention version 2 (revision)

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Methods

Results

Conclusion