Butscher Friederike, Ellinger Jan, Singer Monika, Mall Christoph
TUM School of Medicine and Health, Department Health and Sport Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
Implement Sci Commun. 2024 Feb 12;5(1):12. doi: 10.1186/s43058-024-00548-1.
Health inequity (HI) remains a major challenge in public health. Improving the health of children with low socioeconomic status (SES) can help to reduce overall HI in children. Childhood obesity is a global problem, entailing several adverse health effects. It is crucial to assess the influencing factors for adoption, implementation, and sustainment of interventions. This review aims to identify articles reporting about influencing factors for the implementation of school-based interventions promoting obesity prevention behaviors in children with low SES. It aims to critically appraise the articles' quality, assess influencing factors, categorize and evaluate them, and to discuss possible implications.
A systematic search was conducted in 7 databases with the following main inclusion criteria: (1) school-based interventions and (2) target group aged 5-14 years. The Consolidated Framework for Implementation Research, its five domains (intervention characteristics, inner setting, outer setting, characteristics of individuals, process) along with 39 categories within these domains were used as deductive category system for data analysis. We grouped the articles with regard to the characteristics of the interventions in simple and complex interventions. For each domain, and for the groups of simple and complex interventions, the most commonly reported influencing factors are identified.
In total, 8111 articles were screened, and 17 met all eligibility criteria. Included articles applied mixed methods (n=11), qualitative (n=5), and quantitative design (n=1). Of these, six were considered to report simple interventions and eleven were considered to report complex interventions. In total, 301 influencing factors were assessed. Aspects of the inner setting were reported in every study, aspects of the outer setting were the least reported domain. In the inner setting, most reported influencing factors were time (n=8), scheduling (n=6), and communication (n=6).
This review found a wide range of influencing factors for implementation and contributes to existing literature regarding health equity as well as implementation science. Including all stakeholders involved in the implementation process and assessing the most important influencing factors in the specific setting, could enhance implementation and intervention effectiveness. More empirical research and practical guidance are needed to promote obesity prevention behaviors among children with low SES.
CRD42021281209 (PROSPERO).
健康不平等仍然是公共卫生领域的一项重大挑战。改善社会经济地位低下（SES）儿童的健康状况有助于减少儿童总体健康不平等现象。儿童肥胖是一个全球性问题，会带来多种不良健康影响。评估干预措施的采用、实施和维持的影响因素至关重要。本综述旨在确定报告影响在SES低下儿童中实施促进肥胖预防行为的学校干预措施的相关因素的文章。其目的是批判性地评估文章质量，评估影响因素，对其进行分类和评价，并讨论可能的影响。
在7个数据库中进行了系统检索，主要纳入标准如下：（1）基于学校的干预措施；（2）目标群体年龄在5至14岁之间。实施研究综合框架及其五个领域（干预特征、内部环境、外部环境、个体特征、过程）以及这些领域内的39个类别被用作数据分析的演绎分类系统。我们根据干预措施的特征将文章分为简单干预和复杂干预两类。对于每个领域以及简单和复杂干预组，确定最常报告的影响因素。
总共筛选了8111篇文章，17篇符合所有纳入标准。纳入的文章采用了混合方法（n = 11）、定性方法（n = 5）和定量设计（n = 1）。其中，6篇被认为报告了简单干预措施，11篇被认为报告了复杂干预措施。总共评估了301个影响因素。每项研究均报告了内部环境方面的因素，外部环境方面的因素是报告最少的领域。在内部环境中，最常报告的影响因素是时间（n = 8）、日程安排（n = 6）和沟通（n = 6）。
本综述发现了实施过程中的广泛影响因素，为有关健康公平以及实施科学的现有文献做出了贡献。让实施过程中涉及的所有利益相关者参与进来，并评估特定环境中最重要的影响因素，可以提高实施和干预效果。需要更多的实证研究和实践指导来促进SES低下儿童的肥胖预防行为。
CRD42021281209（PROSPERO）
