A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework

Jennifer C Sanchez-Flack; Annie Herman; Joanna Buscemi; Angela Kong; Alexis Bains; Marian L Fitzgibbon

doi:10.1093/tbm/ibz179

A systematic review of the implementation of obesity prevention interventions in early childcare and education settings using the RE-AIM framework

Transl Behav Med. 2020 Oct 12;10(5):1168-1176. doi: 10.1093/tbm/ibz179.

Authors

Jennifer C Sanchez-Flack¹, Annie Herman², Joanna Buscemi², Angela Kong³, Alexis Bains⁴, Marian L Fitzgibbon⁵

Affiliations

¹ Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.
² Department of Psychology, DePaul University, Chicago, IL, USA.
³ Department of Pharmacy Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
⁴ Department of Kinesiology and Nutrition, College of Applied Health, Sciences, University of Illinois at Chicago, Chicago, IL, USA.
⁵ Department of Pediatrics and University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA.

Abstract

Previous systematic reviews have examined the efficacy of obesity prevention interventions within early childcare/education settings. Often lacking in these reviews is reporting on external validity, which continues to be underemphasized compared to internal validity. More attention to external validity would help better translate evidence-based interventions to real-world settings. This systematic review aimed to determine the availability of data on both internal and external validity across dimensions of the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework in studies reporting on obesity prevention interventions in early childcare/education settings. Inclusion criteria included: randomized controlled trials, early childcare/education setting, targeted children 2-6 years old, addressed both diet and physical activity, collected measures of weight status and diet and/or physical activity, and published within the last 10 years. Searches were conducted in ERIC, PsychInfo, and PubMed; 23 studies met inclusion criteria. A validated RE-AIM abstraction tool was used to code studies. Most commonly reported dimensions were Reach (62.3%), Implementation (53.5%), and Efficacy/Effectiveness (48.7%). Adoption (21.7%) and Maintenance (11.6%) were less often reported. All studies reported on primary outcomes, but few reported on RE-AIM indicators of characteristics of participation and adoption, quality of life, methods used to identify staff, staff inclusion/exclusion criteria and adoption rates, implementation fidelity, measures of cost to start-up and deliver the intervention, and indicators of maintenance. This systematic review underscores the need for more focus on external validity to inform replication, dissemination, and implementation so that evidence-based early childcare/education obesity interventions can be generalized to real-world settings.

Keywords: Early childcare and education; External validity; Implementation; Obesity; RE-AIM framework; Systematic review.

Publication types

Research Support, N.I.H., Extramural
Systematic Review

MeSH terms

Child
Child Rearing*
Child, Preschool
Diet, Healthy
Exercise
Health Promotion*
Humans
Obesity / prevention & control*
Quality of Life*
School Health Services*

Grants and funding

T32 CA057699/CA/NCI NIH HHS/United States