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      Evaluation of a community-based, family focused healthy weights initiative using the RE-AIM framework

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          Abstract

          Background

          Childhood overweight and obesity is a major public health concern. Community-based interventions have the potential to reach caregivers and children. However, the overall health impact of these programs is rarely comprehensively assessed. This study evaluated a physical activity and healthy eating family program (Healthy Together; HT) using the RE-AIM framework.

          Methods

          Ten sites implemented the 5-week program. Thirty-nine staff members and 277 program participants (126 caregivers [ M age  = 35.6] and 151 children [ M age  = 13]) participated in the evaluation. Each RE-AIM dimension was assessed independently using a mixed-methods approach. Sources of data included archival records, interviews and surveys. Effectiveness outcome variables were assessed at pre- and post-intervention and 6-month follow-up.

          Results

          Reach: HT participants were almost entirely recruited from existing programs within sites. Effectiveness: Caregivers’ nutrition related efficacy beliefs increased following HT ( ps < .03). Participation in HT was not associated with significant changes in physical activity or nutrition behaviour or perceived social support ( ps > .05). Knowledge surrounding healthy diets and physical activity increased in children and caregivers ( ps < .05). Adoption: Thirty-five percent of sites approached to implement HT expressed interest. The 10 sites selected recruited existing staff members to implement HT. Implementation: Program objectives were met 72.8% of the time and 71 adaptations were made. HT was finance- and time-dependent. Maintenance: Two sites fully implemented HT in the follow-up year and 5 sites incorporated aspects of HT into other programs.

          Conclusions

          Working alongside organizations that develop community programs to conduct comprehensive, arms-length evaluations can systematically highlight areas of success and challenges. Overall HT represents a feasible community-based intervention; however further support is required in order to ensure the program is effective at positively targeting the desired outcomes. As a result of this evaluation, modifications are currently being implemented to HT.

          Electronic supplementary material

          The online version of this article (10.1186/s12966-017-0638-0) contains supplementary material, which is available to authorized users.

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          Most cited references20

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          Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues.

          Current public health and medical evidence rely heavily on efficacy information to make decisions regarding intervention impact. This evidence base could be enhanced by research studies that evaluate and report multiple indicators of internal and external validity such as Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) as well as their combined impact. However, indices that summarize the combined impact of, and complex interactions among, intervention outcome dimensions are not currently available. We propose and discuss a series of composite metrics that combine two or more RE-AIM dimensions, and can be used to estimate overall intervention impact. Although speculative and, at this point, there have been limited empirical data on these metrics, they extend current methods and are offered to yield more integrated composite outcomes relevant to public health. Such approaches offer potential to help identify interventions most likely to meaningfully impact population health.
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            Obesity and overweight in Canada: an updated cost-of-illness study.

            This study is to update the estimates of the economic burden of illness because of overweight and obesity in Canada by incorporating the increase in prevalence of overweight and obesity, findings of new related comorbidities and rise in the national healthcare expenditure. The burden was estimated from a societal perspective using the prevalence-based cost-of-illness methodology. Results from a literature review of the risks of 18 related comorbidities were combined with prevalence of overweight and obesity in Canada to estimate the extent to which each comorbidity is attributable to overweight and obesity. The direct costs were extracted from the National Health Expenditure Database and allocated to each comorbidity using weights principally from the Economic Burden of Illness in Canada. The study showed that the total direct costs attributable to overweight and obesity in Canada were $6.0 billion in 2006, with 66% attributable to obesity. This corresponds to 4.1% of the total health expenditures in Canada in 2006. The inclusion of newly identified comorbidities increased the direct cost estimates of obesity by 25%, while the rise in national healthcare expenditure accounted for a 19% increase. Policies to reduce being overweight and obese could potentially save the Canadian healthcare system millions of dollars.
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              Attrition in randomized controlled trials for pediatric chronic conditions.

              To examine attrition variables in randomized controlled trials of cognitive behavioral interventions for children with chronic illnesses. We examined attrition rates reported on 40 randomized cognitive behavioral interventions published in six pediatric research journals, during the years 2002-2007. Intervention focus was limited to children with a chronic medical condition, such as asthma, obesity, arthritis, diabetes, cancer, sickle cell disease, and cystic fibrosis. Mean rate of enrollment refusal was 37% (range 0-75%). Mean attrition rate was 20% (range 0-54%) for initial follow-up and 32% (range 0-59%) for extended follow-up. Of the reviewed articles, 40% included a CONSORT diagram. Strategies that can be used to limit attrition include tailoring recruitment to the study population, providing personalized feedback, maintaining consistent study procedures, providing incentives, and using intensive tracking measures. There is a need for standardized definitions and reporting of attrition rates in randomized cognitive behavioral intervention studies.
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                Author and article information

                Contributors
                +1 (250)-807-9670 , mary.jung@ubc.ca
                jessica.bourne@bristol.ac.uk
                hgainfor@mail.ubc.ca
                Journal
                Int J Behav Nutr Phys Act
                Int J Behav Nutr Phys Act
                The International Journal of Behavioral Nutrition and Physical Activity
                BioMed Central (London )
                1479-5868
                26 January 2018
                26 January 2018
                2018
                : 15
                : 13
                Affiliations
                [1 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Health and Exercise Sciences, Faculty of Health and Social Development, , University of British Columbia, ; Kelowna, Canada
                [2 ]ISNI 0000 0004 1936 7603, GRID grid.5337.2, Centre for Exercise, Nutrition and health Sciences, School for Policy Studies, , University of Bristol, ; Bristol, UK
                Author information
                http://orcid.org/0000-0002-2360-0952
                Article
                638
                10.1186/s12966-017-0638-0
                5787319
                29373975
                7f8811a2-7f12-49e8-b1a8-389ab070591e
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 May 2017
                : 18 December 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100011094, Public Health Agency of Canada;
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Nutrition & Dietetics
                program evaluation,children,healthy weight,community,evaluation of a community-based,family focused healthy weights initiative using the re-aim framework

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