Debra Haire-Joshu

A glossary for dissemination and implementation research in health.

Dissemination and implementation (D&I) Research is increasingly Recognized as an important function of academia and is a growing priority for major health-related funders. Because D&I Research in the health field has emerged from Research traditions in diverse disciplines Ranging from agriculture to education, there are inconsistencies in the use and meaning of terms and main concepts. This glossary provides definitions for the key concepts and terms of D&I Research in health (in both public health and clinical settings). Definitions are organized under five major sections: (1) foundation concepts; (2) types of Research; (3) models, theories, and frameworks; (4) factors influencing the D&I processes; and (5) measurement/evaluation of the D&I process. The aim of this glossary is to aid in the development of more standardized and established terminology for D&I Research, facilitate the communication across different stakeholders, and ultimately contribute to higher-quality D&I Research.

High 5 for Kids: The impact of a home visiting program on fruit and vegetable intake of parents and their preschool children

OBJECTIVE The High 5 for Preschool Kids (H5-KIDS) program tested the effectiveness of a home based intervention to teach parents how to ensure a positive fruit-vegetable (FV) environment for their preschool child, and to examine whether changes in parent behavior were associated with improvements in child intake. METHODS A group randomized nested cohort design was conducted (2001 to 2006) in rural, southeast Missouri with 1306 parents and their children participating in Parents As Teachers, a national parent education program. RESULTS When compared to control parents, H5-KIDS parents reported an increase in FV servings (MN=0.20, p=0.05), knowledge and availability of FV within the home (p=0.01), and decreased their use of noncoercive feeding practices (p=0.02). Among preschoolers, FV servings increased in normal weight (MN=0.35, p=0.02) but not overweight children (MN=-0.10, p=0.48), relative to controls. The parents change in FV servings was a significant predictor of childs change in FV in the H5-KIDS group (p=0.001). CONCLUSION H5-KIDS suggests the need for, and promise of, early home intervention for childhood obesity prevention. It demonstrates the importance of participatory approaches in developing externally valid interventions, with the potential for dissemination across national parent education programs as a means for improving the intake of parents and young children.

What Constitutes an Obesogenic Environment in Rural Communities

Purpose. To identify perceived indicators of the physical environment associated with obesity in rural communities. Design. Cross-sectional telephone survey. Setting. Thirteen communities in rural Missouri, Tennessee, and Arkansas, 2003. Subjects. A total of 2510 adults completed the survey and 2210 respondents were included in the analysis (74% female, 93% white, and 27% obese). Measures. The 106-item survey measured perceptions of the neighborhood environment (recreational facilities, land use, transportation/safety, aesthetics, and food environment) and health-related behaviors. The primary outcome was obese (body mass index [BMI] ≥ 30 kg/m2) vs. normal weight (BMI = 18.5–24.9 kg/m2). Analysis. Logistic regression was used to control for age, gender, and education. Results. Several indicators of the perceived neighborhood environment were associated with being obese (adjusted odds ratio [95% confidence interval]), including furthest distance to the nearest recreational facility (1.8 [1.3–2.4]), unpleasant community for physical activity (1.8 [1.3–2.6]), feeling unsafe from crime (2.1 [1.5–2.9]) or traffic (1.7 [1.2–2.3]), and few nonresidential destinations (1.4 [1.0–1.9]). Distance to recreational facilities and crime safety remained significant in the multivariate model, along with dietary-fat intake, sedentary behavior, and moderate/vigorous physical activity. Conclusion. This study adds to a growing evidence base of environmental correlates of obesity and makes a unique contribution regarding rural communities. If causality is established, environmental interventions that target obesogenic neighborhood features may reduce the prevalence of obesity on a population level.

Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities.

OBJECTIVE To examine the association between weight status and characteristics of the food and physical activity environments among adults in rural U.S. communities. METHOD Cross-sectional telephone survey data from rural residents were used to examine the association between obesity (body mass index [BMI] >30 kg/m(2)) and perceived access to produce and low-fat foods, frequency and location of food shopping and restaurant dining, and environmental factors that support physical activity. Data were collected from July to September 2005 in Missouri, Arkansas, and Tennessee. Logistic regression models (N=826) adjusted for age, education and gender comparing normal weight to obese respondents. RESULTS Eating out frequently, specifically at buffets, cafeterias, and fast food restaurants was associated with higher rates of obesity. Perceiving the community as unpleasant for physical activity was also associated with obesity. CONCLUSION Adults in rural communities were less likely to be obese when perceived food and physical activity environments supported healthier behaviors. Additional environmental and behavioral factors relevant to rural adults should be examined in under-studied rural U.S. populations.

Recognition of Childhood Overweight during Health Supervision Visits: Does BMI Help Pediatricians?

Objective: To assess, in diverse pediatric practices, the frequency of overweight/obesity (OW/OB) identification during health supervision visits and its association with BMI curve use.

Preventing Childhood Obesity Through State Policy Predictors of Bill Enactment

BACKGROUND To address the epidemic of childhood obesity, health professionals are examining policies that address obesogenic environments; however, there has been little systematic examination of state legislative efforts in childhood obesity prevention. Using a policy research framework, this study sought to identify factors that predict successful enactment of childhood obesity prevention in all 50 states. METHODS A legislative scan of bills introduced during 2003-2005 in all 50 states identified 717 bills related to childhood obesity prevention. Multilevel logistic regression modeling was performed in 2006 to identify bill-level (procedure, composition, and content) and state-level (sociodemographic, political, economic, and industrial) factors associated with bill enactment. RESULTS Seventeen percent of bills were enacted. Bill-level factors associated with increased likelihood of enactment included having more than one sponsor; bipartisan sponsorship; introduction in the state senate; budget proposals; and content areas related to safe routes to school, walking/biking trails, model school policies, statewide initiatives, and task forces and studies. State-level political factors, including 2-year legislative session and Democratic control of both chambers, increased enactment. An indicator of state socioeconomic status was inversely associated with bill enactment; economic and industrial variables were not significantly related to bill enactment. CONCLUSIONS In general, bill-level factors were more influential in their effect on policy enactment than state-level factors. This study provides policymakers, practitioners, and advocacy groups with strategies to develop more politically feasible childhood obesity prevention policies, including the identification of several modifiable bill characteristics that might improve bill enactment.

The Effect of Disseminating Evidence-Based Interventions That Promote Physical Activity to Health Departments

OBJECTIVES We explored the effect of disseminating evidence-based guidelines that promote physical activity on US health department organizational practices in the United States. METHODS We implemented a quasi-experimental design to examine changes in the dissemination of suggested guidelines to promote physical activity (The Guide to Community Preventive Services) in 8 study states; the remaining states and the Virgin Islands served as the comparison group. Guidelines were disseminated through workshops, ongoing technical assistance, and the distribution of an instructional CD-ROM. The main evaluation tool was a pre- and postdissemination survey administered to state and local health department staffs (baseline n=154; follow-up n=124). RESULTS After guidelines were disseminated through workshops, knowledge of and skill in 11 intervention-related characteristics increased from baseline to follow-up. Awareness-related characteristics tended to increase more among local respondents than among state participants. Intervention adoption and implementation showed a pattern of increase among state practitioners but findings were mixed among local respondents. CONCLUSIONS Our exploratory study provides several dissemination approaches that should be considered by practitioners as they seek to promote physical activity in the populations they serve.

Responses to behaviorally vs culturally tailored cancer communication among African American women.

OBJECTIVE To examine whether tailored cancer communication for African American women can be enhanced by tailoring on 4 sociocultural constructs: religiosity, collectivism, racial pride, and time orientation. METHODS In a randomized trial, participants (n=1,227) received a womens health magazine tailored using behavioral construct tailoring (BCT), culturally relevant tailoring (CRT), or both (COMBINED). Two follow-up interviews assessed responses to the magazines. RESULTS Responses to all magazines were positive. The health focus of the magazines was initially obscured in the CRT condition, but this disappeared over time, and CRT magazines were better liked. CONCLUSIONS Implications for developing and understanding effects of tailored cancer communication are discussed.

Preventing Childhood Obesity through State Policy: Qualitative Assessment of Enablers and Barriers

As the prevalence of obesity rapidly climbs among youth in the United States, public health practitioners and policymakers seek effective means of slowing and reversing these trends. Recently, many state laws and regulations addressing childhood obesity have been introduced and enacted. Understanding determinants of such legislation may inform the development and passage of future policies. For this study, key-informant interviews were conducted with 16 legislators and staffers from 11 states in 2005–2006 to examine qualitative factors that enable and impede state-level childhood obesity prevention legislation. Commonly cited factors positively influencing the passage of childhood obesity prevention legislation included national media exposure, introduction of the policy by senior legislators, and gaining the support of key players including parents, physicians, and schools. Noteworthy barriers included powerful lobbyists of companies that produce unhealthy foods and misconceptions about legislating foods at schools. Although the total number of informants was modest, their valuable insights provide policymakers and practitioners with a set of enablers and barriers to be considered when pursuing state-level policy.

Exercise Habits and Exercise Relapse in Persons With Non-Insulin-Dependent Diabetes Mellitus:

Exercise is widely recognized as a crucial component in the management of non-insulin-dependent diabetes mellitus (NIDDM), but little is known about actual exercise practices in this group. This study investigated exercise habits in 60 persons with NIDDM and 60 nondiabetic significant others. Despite the importance of exercise, most of the persons with NIDDM in our study were not exercising regularly, and the percent of persons exercising regularly was no greater in the diabetic group than in the group of significant others. Although those with NIDDM reported more frequent discussion about exercise with health care professionals, only 25% reported receiving specific guidelines for exercise. Diabetic respondents reported a greater number of relapse or dropout episodes than did the nondiabetic significant others, and relapse was associated with increased guilt. Persons with NIDDM appear to receive recommendations to exercise without instruction on exercise maintenance strategies, resulting in more failed attempts to exercise, and increased guilt. Interventions shown to be effective for increasing exercise maintenance need to be incorporated into the diabetic regimen.