Chronic Disease Prevention Intervention Research Articles

Learning health systems to implement chronic disease prevention programs: A novel framework and perspectives from an Australian health service.

Chronic diseases are a considerable burden to health systems, communities, and patients. Much of this burden, however, could be prevented if interventions effective in reducing chronic disease risks were routinely implemented. The aim of this paper is to discuss the role of public health agencies in preventing chronic disease through the application of learning health system (LHS) approaches to improve the implementation of evidence-based interventions. We draw on the literature and our experience operating a local LHS in Australia that has achieved rapid improvements in the implementation of chronic disease prevention interventions. The proposed LHS framework has been adapted to be both implementation and chronic disease prevention focused. The framework describes both broad improvement processes, and the infrastructure and other support (pillars) recommended to support its core functions. The framework serves as a basis for further exploration of the potentially transformative role LHS's may have in addressing the chronic disease health crisis.

About the Editor: Stephanie L. Fitzpatrick, PhD: Behavioral and Social Care Interventions for Chronic Disease Prevention and Management

About the Editor: Stephanie L. Fitzpatrick, PhD: Behavioral and Social Care Interventions for Chronic Disease Prevention and Management

A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol

BackgroundThe primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research.MethodsThis systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared.Discussion/conclusionThis will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners.Systematic review registrationPROSPERO CRD42022352333.

Development and Functionality of a Parsimonious Digital Food Frequency Questionnaire for a Clinical Intervention among an Indigenous Population

Nutrition-related chronic diseases are a major problem among Indigenous populations. Appropriate dietary intake assessment tools are needed for nutritional surveillance and intervention; however, tools designed to measure the habitual dietary intake of Indigenous persons are largely lacking. We developed a digital food frequency questionnaire (FFQ) to measure habitual consumption among Australian Aboriginal adults and support personalized nutrition counseling. The primary contributors to energy, select nutrients, and inter-person variation (83 food groups) were identified from nationally representative 24 h recall (24HR) data, and they accounted for >80% of the total intake and inter-person variation of the nutrients of interest. Based on community input, a meal-based FFQ format was adopted, with a main food/beverage list of 81 items and the capacity to report on >300 additional items via the digital platform. The nutrient database was based on the Australian Food and Nutrient Database. Data for the first 60 study participants (70% female; median age: 48 years) were used to assess the FFQ’s utility. The participants’ median [IQR] reported energy intake (10,042 [6968–12,175] kJ/day) was similar to their median [IQR] estimated energy expenditure (10,197 [8636–11,551] kJ/day). Foods/beverages on the main FFQ list accounted for between 66% and 90% of the participants’ reported energy and nutrient intakes; the remainder came from participant-selected extra items. The digital FFQ platform provides a potentially valuable resource for monitoring habitual dietary intake among Aboriginal adults and supporting chronic disease prevention and management interventions.

"ActuaYa": A Preliminary Efficacy Study of a Chronic Disease Prevention and Health Promotion Intervention for Older Hispanic Women.

Chronic diseases (CDs) are increasingly common among the aging population. Some evidence suggests that older Hispanic women ages 50years and older (OHW) are at an increased risk for CDs and poorer outcomes than other groups. This study investigated the preliminary efficacy of ActuaYa, a culturally tailored CD prevention and health promotion intervention for OHW. A prospective, single-group, repeated measures study (n = 50) was conducted in Florida. Clinical measures and surveys were collected at baseline and post-intervention at 3- and 6-month follow-up. Descriptive statistics, paired-sample t-tests, and McNemar tests were used for analysis. At baseline, more than half of the participants had a CD. Post-intervention results showed a significant decrease in participants' MAP, BMI, and A1C, and a significant increase in self-efficacy for exercise and HIV knowledge compared to baseline measures. The results of this study support the preliminary efficacy of ActuaYa in preventing CDs and increasing health promotion among OHW.

A Qualitative Assessment of a Worksite Nutrition Education Intervention

To assess the experience of participants who had previously completed a Community Chronic Disease Prevention intervention involving a micronutrient-dense plant-rich dietary intervention. Qualitative interviews were conducted individually or in groups of 2-3. There was a total of twelve participants who had completed a Community Chronic Disease Prevention intervention of 9- or 12-week duration. Questions were designed to be open-ended to maximize the diversity of responses and to allow exploration of a full range of participant views. Interviews were conducted at locations convenient to participants. Employees of a university or regional hospital who had completed a Community Chronic Disease Prevention dietary intervention 1.5-2 years previously. Audio-tape interviews were recorded, transcribed verbatim, and analyzed for common themes and thematic patterns. Participants reported their experiences and adherence to the dietary guidelines post-intervention. Common themes were identified, including a sense of well-being and increased mindfulness. Intervention features that facilitated adherence included regular contact, the educational component, and cooking demonstrations and tastings. Barriers to adhering to the intervention included life-long habits, as well as cultural and family issues. Identification of the experiences of individuals who have participated in a Community Chronic Disease Prevention will provide a basis for incorporating social, emotional, and psychological support into future studies.

Reform of the Health Insurance Funding Model to Improve the Care of Noncommunicable Diseases Patients in Saudi Arabia.

Health insurance models are being considered as part of health system reforms in Saudi Arabia. This paper assesses the attributes of health funding models that support better control of non-communicable diseases (NCDs) and perspectives on health insurance as a model from the perspective of patients, clinicians, and managers. The study employed a mixed-methods research design that included quantitative and qualitative data gathering and analysis. Study findings indicated concerns that the current health funding mechanism is financially unsustainable and, as a result, there will be a greater reliance on personal health insurance to support government spending on healthcare. Essential elements of any health insurance model to support effective NCD management identified from a review of the literature and interviews include the following: ensuring continuity of care and equity; funding chronic disease prevention interventions; prioritising primary healthcare; and maintaining the principle of community rating to prevent insurers from discriminating against members. Other desirable attributes for the funding model includes collaboration across primary, secondary, and tertiary care. Healthcare finance reform aimed at adopting and increasing personal health insurance coverage may play a critical role in extending access to healthcare, eliminating health inequities, enhancing population health, and reducing government spending on healthcare if appropriately considered.

Scaling Interventions to Manage Chronic Disease: Innovative Methods at the Intersection of Health Policy Research and Implementation Science

Policy implementation is a key component of scaling effective chronic disease prevention and management interventions. Policy can support scale-up by mandating or incentivizing intervention adoption, but enacting a policy is only the first step. Fully implementing a policy designed to facilitate implementation of health interventions often requires a range of accompanying implementation structures, like health IT systems, and implementation strategies, like training. Decision makers need to know what policies can support intervention adoption and how to implement those policies, but to date research on policy implementation is limited and innovative methodological approaches are needed. In December 2021, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness and the Johns Hopkins Center for Mental Health and Addiction Policy convened a forum of research experts to discuss approaches for studying policy implementation. In this report, we summarize the ideas that came out of the forum. First, we describe a motivating example focused on an Affordable Care Act Medicaid health home waiver policy used by some US states to support scale-up of an evidence-based integrated care model shown in clinical trials to improve cardiovascular care for people with serious mental illness. Second, we define key policy implementation components including structures, strategies, and outcomes. Third, we provide an overview of descriptive, predictive and associational, and causal approaches that can be used to study policy implementation. We conclude with discussion of priorities for methodological innovations in policy implementation research, with three key areas identified by forum experts: effect modification methods for making causal inferences about how policies’ effects on outcomes vary based on implementation structures/strategies; causal mediation approaches for studying policy implementation mechanisms; and characterizing uncertainty in systems science models. We conclude with discussion of overarching methods considerations for studying policy implementation, including measurement of policy implementation, strategies for studying the role of context in policy implementation, and the importance of considering when establishing causality is the goal of policy implementation research.

A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study.

BackgroundCardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited.ObjectiveThis paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM.MethodsThe theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability.ResultsThe target population was Australians aged ≥45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60% (6/10) of the participants owned iPhone Operating System phones, and 40% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30% (3/10) of the participants from completing the registration process. Among the 70% (7/10) of participants who were able to complete the registration process, 71% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants’ feedback to improve these aspects.ConclusionsWe developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing.

Co-Produce, Co-Design, Co-Create, or Co-Construct-Who Does It and How Is It Done in Chronic Disease Prevention? A Scoping Review.

Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions.

Positive attitudes toward legumes are associated with legume intake among adults in Puerto Rico

Legumes are a traditional healthy staple food in Latin America, with great potential for use in diet-related chronic disease prevention interventions. This study aimed to investigate attitudes about legume consumption and associations with dietary intake. Adult participants from the Puerto Rico Assessment of Diet, Lifestyle, and Diseases, who completed a validated food frequency questionnaire and a legumes questionnaire (n = 229) were included. A 25-item Likert scale was used to assess agreement with stated attitudes regarding legumes consumption. Exploratory factor analysis produced 3 factors: (1) taste and perceived benefits; (2) barriers and negative attitudes; and (3) social support and cultural beliefs. A combined attitudes scale was computed, with higher scores indicating more positive attitudes toward legumes. Adjusted linear regression models examined associations between each factor and the combined scale with legumes intake, rice intake, and ratio of legumes to rice intake. Significant positive associations were observed for the taste and perceived benefits factor (β = 0.14; 95% confidence interval [CI], 0.07-0.21) and the social support and cultural beliefs factor (β = 0.14; 95% CI, 0.07-0.22) with legume intake. The social support and cultural beliefs factor was also associated with a higher ratio of legumes to rice intake (β = 1.59; 95% CI, 0.04-3.14). A 3-unit increase in the combined attitudes scale (corresponding to 1 additional positive attitude) was associated with a 0.03 (95% CI, 0.01-0.05) higher servings/day legume intake. The barriers and negative attitudes factor was inversely associated with rice intake (β = -0.10; 95% CI, -0.02 to -0.17) and positively associated with ratio of legumes to rice intake (β = 1.55; 95% CI, 0.03-3.07). Nutritional programs to increase legume intake as a healthy staple food among Puerto Ricans and Hispanic/Latino populations should emphasize building positive attitudes, especially those related to taste, perceived benefits, social support, and cultural beliefs, while diminishing barriers and negative attitudes.

Pathways to Employee Outcomes in a Workplace Health Promotion Program.

This study examined the relationship between employee outcomes and employer implementation of evidence-based interventions (EBIs) for chronic disease prevention. Cross-sectional samples collected at 3 time points in a cluster-randomized, controlled trial of a workplace health promotion program to promote 12 EBIs. King County, WA. Employees of 63 small, low-wage workplaces. Employer EBI implementation; 3 types of employee outcomes: perceived implementation of EBIs; perceived employer support for health; and health-related behaviors, perceived stress, depression risk, and presenteeism. Intent-to-treat and correlation analyses using generalized estimating equations. We tested bivariate associations along potential paths from EBI implementation, through perceived EBI implementation and perceived support for health, to several employee health-related outcomes. The intent-to-treat analysis found similar employee health-related behaviors in intervention and control workplaces at 15 and 24 months. Workplaces implemented varying combinations of EBIs, however, and bivariate associations were significant for 4 of the 6 indicators of physical activity and healthy eating, as well as perceived stress, depression risk, and presenteeism. We did not find significant positive associations for cancer screening and tobacco cessation. Our findings support broader dissemination of EBIs for physical activity and healthy eating, as well as more focus on improving employer support for employee health. They also suggest we need better interventions for cancer screening and tobacco cessation.

Abstract PO-024: Survivorship care plan for cancer prevention and screening for people living with HIV (PLWH)

Abstract BACKGROUND. Over 1.2 million people living with HIV (PLWH) in the US are aging, many with the chance for normal or near-nomal life expectancy. Yet PLWH are at significantly increased risk for non-AIDS associated cancers due to immunocompromise, antiretroviral medications, lifestyle factors, and social determinants of health issues. HIV disproportionately affects Blacks, those from lower socioeconomic status, the uninsured, and the Southern US. Outcomes from PLWH diagnosed wtih cancer are consistently worse compared to those who are HIV negative, even when diagnosed at the same stage. However, PLWH are often unaware of their higher risk status and are infrequently referred for cancer prevention or screening by providers, despite these disparities in screening and outcomes. METHODS: To explore reasons why PLWH did not engage in cancer prevention or screening activities, we partnered with urban and rural community clinics with a mixed methods study design, including a quantitative survey and focus groups. RESULTS: In our sample (N=178), 90.4% Black, 57% female, significant differences were found between rural and urban settings related to guideline-concordant uptake of cancer screening and prevention. Only 37% subjects overall reported participating in regular cancer screening. Among women over 50 years who met criteria for breast cancer screening, 100% of women in the rural setting were screened while 55% of eligible women in the urban community received breast cancer screening (p=0.009). Participants from both settings demonstrated gaps in knowledge of their own cancer risk or need to pursue screening. Urban participants were more likely than rural to strongly disagree wtih the statement that HIV+ individuals are at higher risk for cancer (p<0.001). Qualitative data indicated the main reason why PLWH did not participate in prevention or screening activities was because participants were seldom referred for screening by their HIV clinic provider or informed of their risk status. Other qualitative data themes were shock and surprise at learning of their increased risk, or how certain behaviors might reduce cancer risk. DISCUSSION: Upon reviewing results with community partners, the suggestion was made that an HIV Survivorship Care Plan, similar to a Cancer Survivor Care Plan, be developed that could be part of the medical record. The HIV Survivorship Care Plan would incorporate cancer and other chronic disease screening, prevention interventions, and surveillance that would be important for aging PLWH to ensure both patients and providers adhered to evidence-based practices. CONCLUSIONS: PLWH are at increased risk for cancer incidence and mortality as they age, yet are often overlooked as a high-risk population that could greatly benefit from prevention and screening.The application of an HIV Survivorship Care Plan intervention is a novel approach to reduce disparities and improve quality of care and outcomes for PLWH. The tool will be tested and evaluated through additional community-engaged partnerships targeting PLWH. Citation Format: Theresa W. Gillespie, Loree Mincey, Yuan Liu, Denise Ballard, Kimberly W. Scott, Robert Knott, Minh Ly T. Nguyen, Saurabh Chawla, Joseph Lipscomb, Jessica H. Wells. Survivorship care plan for cancer prevention and screening for people living with HIV (PLWH) [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-024.

Impacts of chronic disease prevention programs implemented by private health insurers: a systematic review

BackgroundChronic diseases contribute to a significant proportion (71%) of all deaths each year worldwide. Governments and other stakeholders worldwide have taken various actions to tackle the key risk factors contributing to the prevalence and impact of chronic diseases. Private health insurers (PHI) are one key stakeholders, particularly in Australian health system, and their engagement in chronic disease prevention is growing. Therefore, we investigated the impacts of chronic disease prevention interventions implemented by PHI both in Australia and internationally.MethodWe searched multiple databases (Business Source Complete, CINAHL, Global Health, Health Business Elite, Medline, PsycINFO, and Scopus) and grey literature for studies/reports published in English until September 2020 using search terms on the impacts of chronic disease prevention interventions delivered by PHIs. Two reviewers assessed the risk of bias using a quality assessment tool developed by Effective Public Healthcare Panacea Project. After data extraction, the literature was synthesised thematically based on the types of the interventions reported across studies. The study protocol was registered in PROSPERO, CRD42020145644.ResultsOf 7789 records, 29 studies were eligible for inclusion. There were predominantly four types of interventions implemented by PHIs: Financial incentives, health coaching, wellness programs, and group medical appointments. Outcome measures across studies were varied, making it challenging to compare the difference between the effectiveness of different intervention types. Most studies reported that the impacts of interventions, such as increase in healthy eating, physical activity, and lower hospital admissions, last for a shorter term if the length of the intervention is shorter.InterpretationAlthough it is challenging to conclude which intervention type was the most effective, it appeared that, regardless of the intervention types, PHI interventions of longer duration (at least 2 years) were more beneficial and outcomes were more sustained than those PHI interventions that lasted for a shorter period.FundingPrimary source of funding was Geelong Medical and Hospital Benefits Association (GMHBA), an Australian private health insurer.

Prevalence and Predictors of Health-Related Internet and Digital Device Use in a Sample of South Asian Adults in Edmonton, Alberta, Canada: Results From a 2014 Community-Based Survey.

BackgroundSouth Asian Canadians are at high risk of developing cardiovascular disease and diabetes. Consumer-oriented health information technology may help mitigate lifestyle risk factors and improve chronic disease self-management.ObjectiveThis study aims to explore the prevalence, patterns, and predictors of the use of the internet, digital devices, and apps for health purposes as well as preferences for future use of eHealth support in South Asian Canadians.MethodsWe conducted a cross-sectional, mixed-mode survey in a convenience sample of 831 South Asian adults recruited at faith-based gathering places, health care settings, and community events in Edmonton, Alberta, in 2014. The 706 responders (mean age 47.1, SD 17.6 years; n=356, 50.4% female; n=509, 72.1% Sikh) who provided complete sociodemographic information were included in the analysis, and the denominators varied based on the completeness of responses to each question. Multivariate logistic regression was used to determine sociodemographic and health status predictors of internet use, being a web-based health information seeker, smartphone or tablet ownership, health app use, and willingness to use various modes of eHealth support.ResultsOf all respondents, 74.6% (527/706) were internet users and 47.8% (336/703) were web-based health information seekers. In addition, 74.9% (527/704) of respondents owned a smartphone or tablet and 30.7% (159/518) of these had a health and fitness app. Most internet users (441/527, 83.7%) expressed interest in using ≥1 mode of eHealth support. Older age, being female, having less than high school education, preferring written health information in languages other than English, and lacking confidence in completing medical forms predicted lack of internet use. Among internet users, factors that predicted web-based health information seeking were being female, use of the internet several times per day, being confident in completing medical forms, and preferring health information in English. Predictors of not owning a smartphone or tablet were being older, preferring health information in languages other than English, having less than high school education, living in Canada for <5 years, having a chronic health condition, and having diabetes. Increasing age was associated with lower odds of having a health app. Preferring health information in languages other than English consistently predicted lower interest in all modes of eHealth support.ConclusionseHealth-based chronic disease prevention and management interventions are feasible for South Asian adults, but digital divides exist according to language preference, education, age, sex, confidence in completing medical forms, and number of years lived in Canada. Community-based, culturally tailored strategies targeting these factors are required to address existing divides and increase the uptake of credible web-based and app-based resources for health purposes.

A culturally and gender responsive stress and chronic disease prevention intervention for low/no-income African American men: The MOCHA moving forward randomized control trial protocol

Low/no-income, African American men are disproportionally burdened by chronic disease resulting from a complex interplay of systemic, sociocultural, and individual factors. These disparities are related to poverty, racism, gender role strain, high levels of stress, low levels of physical activity, and malnutritious diet. Men of Color Health Awareness (MOCHA) is a community-driven movement to address the physical, mental, social, and spiritual needs of men of color. As part of ongoing programming, the MOCHA Standard intervention consists of a 10-week program including: (1) small group discussions of issues particularly relevant to men of color, (2) classes on health topics focusing on chronic disease control, such as nutrition, obesity, high blood pressure, fitness, and the social determinants of health; and (3) 60-min of moderately intensive aerobic exercise twice a week. While the MOCHA Standard intervention has yielded positive results, feedback from previous participants warranted an in-depth sociocultural tailoring of the curriculum to improve community receptiveness, in particular, revising the sessions to “narrativize” the materials to strengthen their potential effectiveness. This manuscript describes the novel recruitment strategies; the development of an enhanced MOCHA+ Stories Matter program that uses narrative communication strategies; and the methodology used to assess the comparative effectiveness of the MOCHA Standard relative to MOCHA+ Stories Matter program in lowering stress and risk of chronic diseases in a randomized controlled trial. The results of this research will contribute to the identification of effective interventions to address health disparities in low-income African-American men and the dissemination of effective chronic disease prevention programming.

Developing co-funded multi-sectoral partnerships for chronic disease prevention: a qualitative inquiry into federal governmental public health staff experience

BackgroundMulti-sectoral partnerships (MSPs) are frequently cited as a means by which governments can improve population health while leveraging the resources and expertise of the private and non-profit sectors. As part of their efforts in this area, the Public Health Agency of Canada (the Agency) introduced a novel funding programme requiring applicants to procure matched resources from private sources to support large-scale interventions for chronic disease prevention. The current literature on MSPs is limited in its applicability to this model of multi-sectoral engagement. The purpose of this study was to explore the experiences of Agency staff working with potential partners to develop programme applications, such that we might identify lessons from adopting this type of partnership approach.MethodsSemi-structured interviews were conducted with the 12 staff working in the MSP programme. Interviews were recorded, transcribed and analysed using thematic analysis. Preliminary themes were used to inform follow up focus-groups sessions. A second round of analysis was conducted guided by a coding paradigm focused on understanding process.ResultsWe identified “experiencing uncertainty” to be a central concept in participants’ accounts of the MSP process, related specifically to the MSP programme’s novel conditions, shifts that occurred in sectoral roles and demands for new capacities. In response, Agency staff employed strategies to clarify partner interests, build trust in inter-sectoral relationships, and support internal and partner capacity. Outcomes associated with this process include impacts on trust between the Agency and potential partners, a deeper understanding of other sectors, and programme adaptations and refinements to address challenges related to the programme model.ConclusionsThe co-funding model employed by the Agency is a potentially popular one for government bodies wanting to leverage funding from private sector sources. Our study identifies the potential challenges that can occur under this model. Some challenges are related to addressing material conditions related to partner capacity, whereas other challenges speak to deeper and more difficult to address concerns regarding trust and alignment of motivations and interests between partners. Future research exploring the challenges associated with specific models of MSP engagement is necessary to inform approaches to addressing complex problems through collaborative efforts.

General practitioners\u2019 perceptions of their practice of evidence-based chronic disease prevention interventions: a quantitative study in Shanghai, China

BackgroundEpidemic chronic diseases pose significant challenges to the improvement of healthcare in China and worldwide. Despite increasing international calls for the inclusion of evidence-based decision-making (EBDM) processes in chronic disease prevention and control programming as well as policymaking, there is relatively little research that assesses the current capacity of physicians and the factors that influence that capacity in China.MethodThis cross-sectional study was conducted in community health centres (CHCs) in Shanghai, China, using multistage cluster sampling. An evidence-based chronic disease prevention (EBCDP) evaluation tool was employed to assess physician EBCDP awareness, adoption, implementation and maintenance based on the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework and using a 7-point Likert scale. Linear regression analysis was used to assess associations between each EBCDP aspect and overall EBCDP status with participant characteristics or organizational factors.ResultA total of 892 physicians from CHCs in Shanghai, China, were assessed. The physicians perceived their awareness (mean = 4.90, SD = 1.02) and maintenance (mean = 4.71, SD = 1.07) of EBCDP to be relatively low. Physicians with relatively lower job titles and monthly incomes (> 9000 RMB) tended to have relatively higher scores for the awareness, adoption, and implementation of EBCDP (P < 0.05). Those who had participated in one program for chronic disease prevention and control were less likely to adopt (b = − 0.284, P = 0.007), implement (b = − 0.292, P = 0.004), and maintain (b = − 0.225, P = 0.025) EBCDP than those who had participated in more programs. Physicians in general practice (Western medicine) had a lower level of awareness of EBCDP than those in other departments (P < 0.0001). Physician from CHCs located in suburban areas had lower scores for awareness (b = − 0.150, P = 0.047), implementation (b = − 0.171, P = 0.029), and maintenance (b = − 0.237, P = 0.002) that those from urban CHCs. Physicians in CHCs affiliated with universities had higher scores on all four EBCDP aspects that those in CHCs not affiliated with a university.ConclusionsThis study provides quantitative evidence illustrating EBCDP practices among physicians in CHCs with various personal and organizational characteristics, respectively. More methods should be provided to increase the awareness of such physicians regarding EBCDP to stimulate the use of EBCDP for their patients and in connection with other public health priorities.

A case study of using the He Pikinga Waiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in M\u0101ori men at risk of diabetes, cardiovascular disease and obesity

BackgroundMāori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework.MethodsThe partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data.ResultsThe co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0).ConclusionThe HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities.Trial registrationRetrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.

Identification of an Obesogenic Dietary Pattern Using Partial Least Squares in a Nationally-Representative Sample of Canadian Adults

Abstract Objectives Hybrid methods of dietary patterns analysis have emerged as a unique and informative way to study diet-disease relationships in nutritional epidemiology research. The objectives of this research were to identify an obesogenic dietary pattern using weighted PLS in nationally-representative Canadian survey data, and to identify key foods and/or beverages associated with the defined obesogenic pattern. Methods Data from one 24-hr dietary recall data from the cross-sectional Canadian Community Health Survey-Nutrition (CCHS) 2015 (n = 12,110 adults) were used. Weighed partial least squares (wPLS) was used to identify an obesogenic dietary pattern from 40 standardized food and/or beverage categories using the variables energy density, fibre density, and total fat as outcomes. The association between the derived dietary pattern and likelihood of obesity was examined using weighted multivariate logistic regression. Key dietary components highly associated with the derived pattern were identified. Results Compared to quartile one (i.e., those least adherent to an obesogenic dietary pattern), those in quartile four had a 2.40-fold increased odds of being obese (OR = 2.40, 95% CI = 1.91, 3.02, P-trend &amp;lt; 0.0001) with a monotonically increasing trend. Using a factor loading significance cut-off of ≥|0.17|, three food/beverage categories loaded positively for the derived obesogenic dietary pattern: fast food, carbonated drinks and salty snacks. Seven food/beverage categories loaded negatively (i.e., in the protective direction): consumption of whole fruits, orange vegetables, “other” vegetables (including vegetable juice), whole grains, dark green vegetables, legumes and soy, and pasta and rice. Conclusions This study pinpoints key dietary components that are associated with obesity and consumed among a nationally-representative sample of Canadians adults. Compared to a similarly-defined obesogenic diet identified by our research group in 2004, the top contributors to a Canadian-specific obesogenic diet in 2015 have remained consistent. This evidence may aid in developing targeted policies and dietary interventions for obesity and chronic disease prevention. Funding Sources Supported by grants from the Burroughs Wellcome Fund Innovation in Regulatory Science Award and the Canadian Institutes of Health Research.