Identifying opportunities to develop the science of implementation for community-based non-communicable disease prevention: A review of implementation trials

Luke Wolfenden; Kathryn Reilly; Melanie Kingsland; Alice Grady; Christopher M Williams; Nicole Nathan; Rachel Sutherland; John Wiggers; Jannah Jones; Rebecca Hodder; Meghan Finch; Tameka McFadyen; Adrian Bauman; Chris Rissel; Andrew Milat; Taren Swindle; Sze Lin Yoong

doi:10.1016/j.ypmed.2018.11.014

Identifying opportunities to develop the science of implementation for community-based non-communicable disease prevention: A review of implementation trials

Prev Med. 2019 Jan:118:279-285. doi: 10.1016/j.ypmed.2018.11.014. Epub 2018 Nov 20.

Authors

Luke Wolfenden¹, Kathryn Reilly², Melanie Kingsland³, Alice Grady⁴, Christopher M Williams⁵, Nicole Nathan⁶, Rachel Sutherland⁷, John Wiggers⁸, Jannah Jones⁹, Rebecca Hodder¹⁰, Meghan Finch¹¹, Tameka McFadyen¹², Adrian Bauman¹³, Chris Rissel¹⁴, Andrew Milat¹⁵, Taren Swindle¹⁶, Sze Lin Yoong¹⁷

Affiliations

¹ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: luke.wolfenden@hnehealth.nsw.gov.au.
² School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: kathryn.reilly@hnehealth.nsw.gov.au.
³ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: melanie.kingsland@hnehealth.nsw.gov.au.
⁴ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: alice.grady@hnehealth.nsw.gov.au.
⁵ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia; Musculoskeletal Division, The George Institute for Global Health, Sydney, Australia. Electronic address: christopher.m.williams@hnehealth.nsw.gov.au.
⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: nicole.nathan@hnehealth.nsw.gov.au.
⁷ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: rachel.sutherland@hnehealth.nsw.gov.au.
⁸ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: john.wiggers@hnehealth.nsw.gov.au.
⁹ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: jannah.jones@hnehealth.nsw.gov.au.
¹⁰ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: rebecca.hodder@hnehealth.nsw.gov.au.
¹¹ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: meghan.finch@hnehealth.nsw.gov.au.
¹² School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: tameka-rae.small@hnehealth.nsw.gov.au.
¹³ School of Public Health, The University of Sydney, Sydney, Australia; Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine University of Sydney, NSW, Australia. Electronic address: adrian.bauman@sydney.edu.au.
¹⁴ Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine University of Sydney, NSW, Australia. Electronic address: Chris.Rissel@health.nsw.gov.au.
¹⁵ Centre for Epidemiology and Evidence, NSW Ministry of Health, North Sydney, Australia. Electronic address: amila@doh.health.nsw.gov.au.
¹⁶ College of Medicine, Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States. Electronic address: TSwindle@uams.edu.
¹⁷ School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, New South Wales 2308, Australia; Hunter New England Population Health, Wallsend, New South Wales 2287, Australia. Electronic address: serene.yoong@hnehealth.nsw.gov.au.

PMID: 30468794
DOI: 10.1016/j.ypmed.2018.11.014

Abstract

Implementation of interventions in community organisations such as schools, childcare centres, and sporting clubs are recommended to target a range of modifiable risks of non-communicable diseases. Poor implementation, however, is common and has contributed to the failure of non-communicable disease interventions globally. This study aimed to characterise experimental research regarding strategies to improve implementation of chronic disease prevention programs in community settings. The review used data collected in three comprehensive systematic reviews undertaken between August 2015 and July 2017. Randomised controlled trials, including cluster design, and non-randomised trials with a parallel control group were included. The data were extracted to describe trial characteristics, implementation strategies employed, implementation outcomes and study quality. Of the 40 implementation trials included in the study, unhealthy diet was the most common risk factor targeted (n = 20). The most commonly reported implementation strategies were educational meetings (n = 38, 95%), educational materials (n = 36, 90%) and educational outreach visits (n = 29, 73%). Few trials were conducted 'at-scale' (n = 8, 20%) or reported adverse effects (n = 5, 13%). The reporting of implementation related outcomes; intervention adoption (n = 13, 33%); appropriateness (n = 11, 28%); acceptability (n = 8, 20%); feasibility (n = 8, 20%); cost (n = 3, 8%); and sustainability (n = 2, 5%); was limited. For the majority of trials, risk of bias was high for blinding of study personnel/participants and outcome assessors. Testing of strategies to improve implementation of non-communicable disease prevention strategies in community settings, delivered 'at-scale', utilising implementation frameworks, including a comprehensive range of implementation outcomes should be priority areas for future research in implementation science.

Keywords: Community settings; Implementation; Non-communicable diseases; Prevention.

Publication types

Review

MeSH terms

Community-Based Participatory Research*
Diet, Healthy
Health Education*
Humans
Implementation Science*
Noncommunicable Diseases / prevention & control*