Policy, Systems, and Environmental Approaches to Obesity Prevention: Translating and Disseminating Evidence from Practice.

To reduce obesity prevalence, public health practitioners are intervening to change health behaviors as well as the policies, systems, and environments (PSEs) that support healthy behaviors. Although the number of recommended PSE intervention strategies continues to grow, limited guidance is available on how to implement those strategies in practice. This article describes the University of North Carolina at Chapel Hill, Center for Training and Research Translation's (Center TRT's) approach to reviewing, translating, and disseminating practitioner-developed interventions, with the goal of providing more practical guidance on how to implement PSE intervention strategies in real-world practice. As of August 2014, Center TRT had disseminated 30 practice-based PSE interventions. This article provides an overview of Center TRT's process for reviewing, translating, and disseminating practice-based interventions and offers key lessons learned during the nine years that Center TRT has engaged in this work.

A systematic approach to evaluating public health training: the obesity prevention in public health course.

OBJECTIVE: Public health practitioners require new knowledge and skills to address the multilevel factors contributing to obesity. This article presents the systematic approach the Center of Excellence for Training and Research Translation (Center TRT) used both to assess practitioners' competencies to lead public health obesity prevention initiatives and to evaluate its annual, competency-based obesity prevention course. DESIGN: In 2006, Center TRT identified priority public health competencies for obesity prevention and then planned 7 annual courses to address the priority competencies progressively over time. Each year, a longitudinal evaluation based on Kirkpatrick's training evaluation framework was administered to course participants (n = 243) to assess perceptions of the course (daily), changes in self-reported competency (immediately pre- and postcourse), and course impact on practice over time (at 6 months). RESULTS: Participants rated the course highly for quality and relevance. Although many participants reported low levels of confidence prior to the course, following the course, at least 70% reported feeling confident to perform almost all competencies. At 6-month follow-up, the majority of participants reported completing at least 1 activity identified during course action planning. CONCLUSIONS: We identified practitioners' high-priority competency needs and then designed 7 annual courses to progressively address those needs and new needs as they arose. This approach resulted in trainings valued by practitioners and effective in increasing their sense of competence to lead public health obesity prevention initiatives. The course's continuing impact was evidenced by participants' high level of completion of their action plans at 6-month follow-up. Competency-based training is important to develop a skilled public health workforce.

The role of community, state, territorial, and tribal public health in obesity prevention.

This article explores how governmental public health authorities can contribute to public health efforts to address obesity by monitoring the prevalence of obesity and associated risk factors, investigating the contributing factors, informing the public, and working with the citizens in their jurisdiction to develop solutions that fit the needs and sensibilities of the people.

An evaluation framework for obesity prevention policy interventions.

As the emphasis on preventing obesity has grown, so have calls for interventions that extend beyond individual behaviors and address changes in environments and policies. Despite the need for policy action, little is known about policy approaches that are most effective at preventing obesity. The Centers for Disease Control and Prevention (CDC) and others are funding the implementation and evaluation of new obesity prevention policies, presenting a distinct opportunity to learn from these practice-based initiatives and build the body of evidence-based approaches. However, contributions from this policy activity are limited by the incomplete and inconsistent evaluation data collected on policy processes and outcomes. We present a framework developed by the CDC-funded Center of Excellence for Training and Research Translation that public health practitioners can use to evaluate policy interventions and identify the practice-based evidence needed to fill the gaps in effective policy approaches to obesity prevention.

Applying the RE-AIM framework to assess the public health impact of policy change.

BACKGROUND AND PURPOSE: Planning and evaluation models have been developed to assess the public health impact of health promotion interventions. However, few have been applied to health policies. There is an important need for models to help design and evaluate health policies. METHODS: This article applies the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) planning and evaluation framework to health policies. We provide definitions and application examples for different policies. RESULTS: As demonstrated by a case study, the RE-AIM dimensions and definitions can also apply to policies. Considerations regarding compliance and enforcement are presented to clarify the complex implementation dimension. CONCLUSIONS: The RE-AIM framework can be useful in estimating public health impact, comparing different health policies, planning policies designed for increased likelihood of success, and identifying areas for integration of policies with other health promotion strategies.

An intervention to promote healthy weight: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) theory and design.

Health professionals are faced with the growing challenge of addressing childhood overweight. Few overweight prevention efforts have targeted young children, particularly children in child care settings. We describe the theory and development of a novel nutrition and physical activity environmental intervention. On the basis of findings from interviews and focus groups, a review of national recommendations and standards, and a review of the literature, we developed a nutrition and physical activity environmental self-assessment instrument to assess physical activity and nutrition policies and practices in child care settings. An intervention model was built around existing public health infrastructure to support use of the self-assessment instrument and encourage environmental changes at the child care level, and this intervention model became the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) program. The NAP SACC program was designed for dissemination and has potential for implementation in many settings. Broad interest in NAP SACC has been expressed by a number of states and institutions, and many groups are using NAP SACC intervention and materials. The NAP SACC program shows promise as a useful approach to promoting healthy weight behaviors in child care settings.

Nutrition and physical activity self-assessment for child care (NAP SACC): results from a pilot intervention.

OBJECTIVE: To determine the feasibility, acceptability, and reported impact of a nutrition and physical activity environmental intervention in child care. DESIGN: Self-assessment instrument completed pre- and post-intervention by randomly assigned intervention and comparison child care centers. SETTING: Child care centers in 8 counties across North Carolina. PARTICIPANTS: A convenience sample of 19 child care centers (15 intervention and 4 comparison). INTERVENTION: Intervention centers completed the self-assessment instrument at baseline and then selected 3 environmental improvements to make over the 6-month intervention period with assistance from a trained NAP SACC Consultant. MAIN OUTCOME MEASURE: Changes in pre- and post-intervention self-assesment of the nutrition and physical activity child care environment with additional process measures to evaluate project implementation, feasibility and acceptability. ANALYSIS: Comparison of pre- and post-test scores for the intervention group using a Wilcoxon signed-rank test and descriptions of environmental changes. RESULTS: Intervention centers rated themselves higher at follow-up than at baseline, and relative to comparison centers, reported a variety of environmental nutrition and physical activity improvements confirmed by research staff. CONCLUSIONS AND IMPLICATIONS: The NAP SACC pilot intervention shows promise as an approach to promote healthy weight environments in preschool settings. Additional evaluation of the project is needed using a greater number of centers and a more objective outcome measure.