applying theoretical frameworks to evaluate a community-based … · 2019-05-14 · top 5 bcts:...

Applying Theoretical Frameworks to Evaluate a Community-Based Health Behaviour Intervention in Ontario: Comparing Theme 1 and 2 of the Healthy Kids Community Challenge

Sunita Tanna

March 27, 2019

The Ontario Public Health Convention (TOPHC), Toronto ON

Rachel E. Laxer

DISCLOSURE OF COMMERCIAL

SUPPORT

• None of the presenters at this session have received

financial support or in-kind support from a commercial

sponsor.

• None of the presenters have potential conflicts of interest to

declare.

PublicHealthOntario.ca

Overview of the Ontario HKCC

4

Multi-year community-based health promotion intervention targeting children and youth in Ontario

Supported by the Ministry of Health and Long-Term Care (funding, training, and social marketing tools)

45 Ontario communities (39 municipally-funded; 6 Aboriginal stream) worked with local public/private partners to develop & implement programs, policies, environmental supports to promote healthy behaviours

Approximately $33.5 million of dedicated funding from MOHLTC from 2015-2018


HKCC Goals and

Objectives

5

Reduce the prevalence, and

prevent childhood overweight and obesity in HKCC

communities

Increase awareness and participation in HKCC program

Create supportive

environments to enable healthy

behaviours

Increase the proportion of

children engaging in healthy behaviours

and parents engaging in supportive behaviours

Increase community capacity for sustainable

interventions

Improve community

collaboration through

partnerships

Contribute to the evidence on community-

based interventions


HKCC Design

6

• Four themes each 9-months in duration, targeting different health behaviours

Theme 4:

Power Off and Play!

Theme 3:

Choose to Boost Veggies

and Fruit

Theme 2:

Water Does Wonders

Theme 1:

Run. Jump. Play. Every

Day.


HKCC Evaluation Components

7

Process Implementation

Evaluation

• Implementation and factors contributing to implementation

Outcomes Evaluation

• Effectiveness of HKCC for increasing healthy behaviours, and reducing the prevalence and preventing childhood overweight and obesity in Ontario

Aboriginal Stream Evaluation

• CIHR-funded, community-partnered evaluation of the implementation and impacts in six Indigenous communities


Purpose: Component of the Process Implementation Evaluation

8

To assess the extent to which:

The HKCC is being implemented as planned within and across HKCC

communities by comparing planned vs. implemented

interventions

Behaviour change techniques (BCTs) can be

identified within the description of community

interventions


Methods

9

• Mixed-method analyses of data from reporting tools, guided by:

RE-AIM Framework

Behaviour Change Technique (BCT) Taxonomy

Behaviour Change Wheel

• Using relevant data, examined:

• Reach, implementation, partnerships

• The application of behaviour change theories to descriptions of communities’ interventions


RE-AIM Framework

10

Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322-7.

• Individual-level measure of participation in HKCC Reach

• Measured in outcomes evaluation Effectiveness

• Range and representativeness of settings adopting the HKCC Adoption

• Extent to which a program is delivered as intended (setting level, intervention delivery) Implementation

• Extent to which HKCC becomes part of routine practice, and organizations integrate Maintenance


Results: RE-AIM Comparing Themes 1 and 2 (Implementation)

11

Program/Activity Supportive Environment Policy

• Series of activities or products or services to facilitate change among a well-defined target group

• Ensuring that both indoor and outdoor environments are perceived as safe, interesting, user-friendly and accessible

• A law, regulation, procedure, administrative action, incentive or voluntary practice of government and other institutions

Theme 1 Theme 2 Theme 1 Theme 2 Theme 1 Theme 2

71.8% 57.1% 24.9% 35.2% 3.3% 7.7%

Total # of Interventions

Theme 1:

575

Theme 2:

278


Results: RE-AIM Comparing Themes 1 and 2 (Reach)

12

1.1 1.2

0.6

2.6

0

0.5

1

1.5

2

2.5

3

Children Total Reach

Rea

ch

(mill

ion

s)

Run. Jump. Play. Every Day. Water Does Wonders


Results: RE-AIM Comparing Themes 1 and 2 (Adoption)

13

Total # of Partnerships

Theme 1:

1577

Theme 2:

1817

392

323

189

179

115

90

79

56

32

277

269

159

128

157

153

87

93

47

0 50 100 150 200 250 300 350 400 450

Schools/School Boards

Local Municipality

Public Health

Local Business

Sport/Recreation

Non-Profit

Health Care Organization

Child Care Centre

First Nations

Partners Involved in Implementation

Run. Jump. Play. Every Day. Water Does Wonders


Behaviour Change Techniques (BCTs)

14

Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychology & health, 26(11), 1479-1498.

Improving implementation and

effectiveness of public health interventions depends on

behaviour change

• Theory-based components of interventions that bring about change

• Provide common language to describe intervention content and characterize interventions

• Important to identify to understand underlying determinants of behaviour change

• Coding interventions using BCTs allows to understand implementation better and which techniques are more effective at changing behaviour

BCTs:


Methods: Behaviour Change Technique (BCT) Taxonomy

15

Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychology & health, 26(11), 1479-1498.

Guided by a 40-item BCT taxonomy

Use BCTs to characterize content within interventions and for implementation fidelity

TBAP/PAR interventions descriptions provided by LPMs were coded using a line-by-line procedure to identify which BCT(s) were used

PublicHealthOntario.ca 16

Coding using BCT Taxonomy – HKCC Examples

“Dance Club will be offered twice per week. A qualified dance instructor will lead children and teach a variety of dance styles”

“Students will explore opportunities for transforming their physical environment to facilitate movement, collaboration and creativity which may include standing desks, mini trampolines, seat pedals, exercise balls.”

Prompt practice Provide instruction on how to perform the behaviour

Model/ demonstration the behaviour

Environmental Restructuring


Results: Theme 1 – BCT Taxonomy

17

Across 39-municipal HKCC communities, 410 of 575 implemented interventions had at least 1 identifiable BCT

• 1,026 BCTs assigned

• 27 of 40 unique BCTs identified across 410 interventions Top 5 BCTs:

• Prompting generalization of a target behaviour

• Provide instruction on how to perform the behaviour

• Model/demonstrate the behaviour

• Prompt practice

• Barrier identification/problem solving


Discussion: Theme 1 – BCT Taxonomy

18

Value in coding intervention using BCTs to understand implementation better

However, BCT taxonomy may not be the most appropriate method to code community-based interventions because of its focus on individual behaviour change

Might be best to apply another coding scheme more relevant to population-based interventions


Behaviour Change Wheel

19

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science, 6(1), 42.

• Synthesis of 19 frameworks of behaviour change

• Can be used for designing and evaluating behaviour change interventions

• Consists of 3 layers:

Inner:

Middle:

Outer:


Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation science. 2011 Apr 23;6(1):42.

Intervention Functions (IFs) Education Persuasion

Modelling Restriction

Training Incentivization

Environmental Restructuring Enablement

*

• IFs are categories by which an intervention might change behaviour

• Using function instead of type allows for interventions to be classified as having more than one function


Intervention Functions – Theme 2 HKCC Examples

Education

• An educational forum highlighted the importance of water consumption over sugar-sweetened beverages and physical health.

Enablement

• The Blue W program provides mapped details on where to find clean, free, public and commercial sources to fill reusable bottle without compelling the consumer to make additional purchases.

Environmental Restructuring

• Water fountain and bottle refill combination units have been installed in eight locations across the city that have high traffic of children and community members.


Results: Theme 2 – Intervention Functions

22

Across 39 municipal-HKCC communities, 259/278 implemented interventions had at least one identifiable IF

• 375 IFs assigned

Top 3 IFs:

• Education

• Enablement

• Environmental restructuring


Recoding Theme 1– Comparing BCT vs. IF

23

•BCTs: Prompt practice, provide instruction on how to perform the behaviour, model/ demonstration the behaviour •IFs: Training, Modelling

“Dance Club will be offered twice per week. A qualified dance instructor

will lead children and teach a variety of dance

styles”

• BCT: Environmental restructuring

• IF: Environmental restructuring

“Students will explore opportunities for

transforming their physical environment which may include standing desks, mini trampolines, seat pedals, exercise balls”


Discussion

24

Results based on RE-AIM differed across themes

Use of a behaviour change theory useful for evaluators to understand purpose of intervention

BCT taxonomy insufficient given its focus on individual-level

IFs better at classifying community-level interventions


Future Directions

Evaluation of the remaining themes of the HKCC

First project to code community-based interventions against behaviour change framework

Ideally, incorporate behaviour change during the program design phase

Public Health Ontario keeps Ontarians safe and healthy. Find out more at PublicHealthOntario.ca

For More Information About This Presentation, Contact:

Sunita Tanna ([email protected])

Rachel Laxer ([email protected])

mailto:[email protected]

mailto:[email protected]

applying theoretical frameworks to evaluate a community-based … · 2019-05-14 · top 5 bcts:...

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