BackgroundThe Medical Research Council published the second edition of its framework in 2006 on d... more BackgroundThe Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods.MethodsThere were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert re...
Purpose The teaching of cooking is an important aspect of school-based efforts to promote healthy... more Purpose The teaching of cooking is an important aspect of school-based efforts to promote healthy diets among children, and is frequently done by external agencies. Within a limited evidence base relating to cooking interventions in schools, there are important questions about how interventions are integrated within school settings. The purpose of this paper is to examine how a mobile classroom (Cooking Bus) sought to strengthen connections between schools and cooking, and drawing on the concept of the sociotechnical network, theorise the interactions between the Bus and school contexts. Design/methodology/approach Methods comprised a postal questionnaire to 76 schools which had received a Bus visit, and case studies of the Bus’ work in five schools, including a range of school sizes and urban/rural locations. Case studies comprised observation of Cooking Bus sessions, and interviews with school staff. Findings The Cooking Bus forged connections with schools through aligning interve...
BackgroundIn contrast to curriculum-based health education interventions in schools, the school e... more BackgroundIn contrast to curriculum-based health education interventions in schools, the school environment approach promotes health by modifying schools' physical/social environment. This systematic review reports on the health effects of the school environment and processes by which these might occur. It includes theories, intervention outcome and process evaluations, quantitative studies and qualitative studies.Research questionsResearch question (RQ)1: What theories are used to inform school environment interventions or explain school-level health influences? What testable hypotheses are suggested? RQ2: What are the effects on student health/inequalities of school environment interventions addressing organisation/management; teaching/pastoral care/discipline; and the physical environment? What are the costs? RQ3: How feasible/acceptable and context dependent are such interventions? RQ4: What are the effects on student health/inequalities of school-level measures of organisat...
Background: Fidelity evaluation is particularly important in pragmatic studies, which afford grea... more Background: Fidelity evaluation is particularly important in pragmatic studies, which afford greater potential for variation than explanatory trials. The Project SFP Cymru process evaluation has examined adherence, exposure, quality of delivery, participant engagement and programme differentiation during a randomised controlled trial of the Strengthening Families Programme (SFP10-14UK) involving more than 700 families. SFP10-14UK was delivered by local voluntary and statutory bodies in seven areas of Wales. Training, funding and programme manuals were provided as they would be in a non-research context and there were no special measures to control programme delivery. Methods: Data collection comprised: thirty-three interviews with and self-report data from programme staff; observation of programme sessions; and routine data from each area. Descriptive analyses of quantitative data were conducted with appropriate tests of significance and reliability. A thematic framework was develop...
The international journal of behavioral nutrition and physical activity, Jan 25, 2015
This study examined the nutritional intake of 9-11 year old children in Wales, UK, to assess the ... more This study examined the nutritional intake of 9-11 year old children in Wales, UK, to assess the rationale for, and potential of, school breakfast initiatives. It also examined the possible unintended consequence of over consumption. The study employed a cross-sectional observational design within a randomized controlled trial of a free school breakfast programme. A total of 111 primary schools were randomly assigned to an intervention condition (in which a free school breakfast programme was implemented) or a control condition (in which implementation of the scheme was delayed). Sub-samples of children completed multiple-pass 24-hr dietary recall interviews at baseline (n = 581), and 12 months later (n = 582). Deprivation was assessed for each child in terms of whether or not they were entitled to free school meals. Prior to the introduction of the programme, rates of breakfast skipping were low and there was little evidence of widespread nutritional deficiency. However, there was ...
This chapter contains sections titled: Summary and recommendations for research Introduction Eval... more This chapter contains sections titled: Summary and recommendations for research Introduction Evaluation: purpose and resources Complexity: moving beyond “what works?” Evaluating complex interventions — research stages and research questions Formative evaluation Summative evaluation Evaluation funding Conclusion Acknowledgements References
BackgroundThe value placed on types of evidence within decision-making contexts is highly depende... more BackgroundThe value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.MethodsThe study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate i...
ObjectiveThe present study evaluated the impact of a national school programme of universal free ... more ObjectiveThe present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK.DesignA cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour.SettingPrimary schools in nine local education authority areas.SubjectsA total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools.ResultsStudents in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other signif...
The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally d... more The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. Significant differences in the Debris Inde...
Background Childhood overweight and obesity is the most prevalent and, arguably, politically comp... more Background Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision-making in local governments, within the context of childhood obesity prevention as a national policy priority. Methods/Design This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. ...
BackgroundThe Medical Research Council published the second edition of its framework in 2006 on d... more BackgroundThe Medical Research Council published the second edition of its framework in 2006 on developing and evaluating complex interventions. Since then, there have been considerable developments in the field of complex intervention research. The objective of this project was to update the framework in the light of these developments. The framework aims to help research teams prioritise research questions and design, and conduct research with an appropriate choice of methods, rather than to provide detailed guidance on the use of specific methods.MethodsThere were four stages to the update: (1) gap analysis to identify developments in the methods and practice since the previous framework was published; (2) an expert workshop of 36 participants to discuss the topics identified in the gap analysis; (3) an open consultation process to seek comments on a first draft of the new framework; and (4) findings from the previous stages were used to redraft the framework, and final expert re...
Purpose The teaching of cooking is an important aspect of school-based efforts to promote healthy... more Purpose The teaching of cooking is an important aspect of school-based efforts to promote healthy diets among children, and is frequently done by external agencies. Within a limited evidence base relating to cooking interventions in schools, there are important questions about how interventions are integrated within school settings. The purpose of this paper is to examine how a mobile classroom (Cooking Bus) sought to strengthen connections between schools and cooking, and drawing on the concept of the sociotechnical network, theorise the interactions between the Bus and school contexts. Design/methodology/approach Methods comprised a postal questionnaire to 76 schools which had received a Bus visit, and case studies of the Bus’ work in five schools, including a range of school sizes and urban/rural locations. Case studies comprised observation of Cooking Bus sessions, and interviews with school staff. Findings The Cooking Bus forged connections with schools through aligning interve...
BackgroundIn contrast to curriculum-based health education interventions in schools, the school e... more BackgroundIn contrast to curriculum-based health education interventions in schools, the school environment approach promotes health by modifying schools' physical/social environment. This systematic review reports on the health effects of the school environment and processes by which these might occur. It includes theories, intervention outcome and process evaluations, quantitative studies and qualitative studies.Research questionsResearch question (RQ)1: What theories are used to inform school environment interventions or explain school-level health influences? What testable hypotheses are suggested? RQ2: What are the effects on student health/inequalities of school environment interventions addressing organisation/management; teaching/pastoral care/discipline; and the physical environment? What are the costs? RQ3: How feasible/acceptable and context dependent are such interventions? RQ4: What are the effects on student health/inequalities of school-level measures of organisat...
Background: Fidelity evaluation is particularly important in pragmatic studies, which afford grea... more Background: Fidelity evaluation is particularly important in pragmatic studies, which afford greater potential for variation than explanatory trials. The Project SFP Cymru process evaluation has examined adherence, exposure, quality of delivery, participant engagement and programme differentiation during a randomised controlled trial of the Strengthening Families Programme (SFP10-14UK) involving more than 700 families. SFP10-14UK was delivered by local voluntary and statutory bodies in seven areas of Wales. Training, funding and programme manuals were provided as they would be in a non-research context and there were no special measures to control programme delivery. Methods: Data collection comprised: thirty-three interviews with and self-report data from programme staff; observation of programme sessions; and routine data from each area. Descriptive analyses of quantitative data were conducted with appropriate tests of significance and reliability. A thematic framework was develop...
The international journal of behavioral nutrition and physical activity, Jan 25, 2015
This study examined the nutritional intake of 9-11 year old children in Wales, UK, to assess the ... more This study examined the nutritional intake of 9-11 year old children in Wales, UK, to assess the rationale for, and potential of, school breakfast initiatives. It also examined the possible unintended consequence of over consumption. The study employed a cross-sectional observational design within a randomized controlled trial of a free school breakfast programme. A total of 111 primary schools were randomly assigned to an intervention condition (in which a free school breakfast programme was implemented) or a control condition (in which implementation of the scheme was delayed). Sub-samples of children completed multiple-pass 24-hr dietary recall interviews at baseline (n = 581), and 12 months later (n = 582). Deprivation was assessed for each child in terms of whether or not they were entitled to free school meals. Prior to the introduction of the programme, rates of breakfast skipping were low and there was little evidence of widespread nutritional deficiency. However, there was ...
This chapter contains sections titled: Summary and recommendations for research Introduction Eval... more This chapter contains sections titled: Summary and recommendations for research Introduction Evaluation: purpose and resources Complexity: moving beyond “what works?” Evaluating complex interventions — research stages and research questions Formative evaluation Summative evaluation Evaluation funding Conclusion Acknowledgements References
BackgroundThe value placed on types of evidence within decision-making contexts is highly depende... more BackgroundThe value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions.MethodsThe study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate i...
ObjectiveThe present study evaluated the impact of a national school programme of universal free ... more ObjectiveThe present study evaluated the impact of a national school programme of universal free healthy breakfast provision in Wales, UK.DesignA cluster randomised controlled trial with repeated cross-sectional design and a 12-month follow-up. Primary outcomes were breakfast skipping, breakfast diet and episodic memory. Secondary outcomes were frequency of eating breakfast at home and at school, breakfast attitudes, rest-of-day diet and class behaviour.SettingPrimary schools in nine local education authority areas.SubjectsA total of 4350 students (aged 9–11 years) at baseline and 4472 at follow-up in 111 schools.ResultsStudents in intervention schools reported significantly higher numbers of healthy food items consumed at breakfast and more positive attitudes towards breakfast eating at 12 months. Parents in intervention schools reported significantly higher rates of consumption of breakfast at school and correspondingly lower rates of breakfast consumption at home. No other signif...
The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally d... more The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. Significant differences in the Debris Inde...
Background Childhood overweight and obesity is the most prevalent and, arguably, politically comp... more Background Childhood overweight and obesity is the most prevalent and, arguably, politically complex child health problem internationally. Governments, communities and industry have important roles to play, and are increasingly expected to deliver an evidence-informed system-wide prevention program. However, efforts are impeded by a lack of organisational access to and use of research evidence. This study aims to identify feasible, acceptable and ideally, effective knowledge translation (KT) strategies to increase evidence-informed decision-making in local governments, within the context of childhood obesity prevention as a national policy priority. Methods/Design This paper describes the methods for KT4LG, a cluster randomised controlled trial which is exploratory in nature, given the limited evidence base and methodological advances. KT4LG aims to examine a program of KT strategies to increase the use of research evidence in informing public health decisions in local governments. ...
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