Background
The Australian health care system context
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To what extent were overarching corporate systems important to ongoing service delivery, i.e. were the key barriers and enablers for ongoing service delivery consistent across States for sites with similar levels of implementation?
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Within each State, did the perspectives of central agencies reflect the barriers and enablers identified by service sites? Did this vary according to level of implementation?
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Given that NSW achieved ongoing service delivery and Queensland did not, was there a difference in the perceptions of central agency staff between States?
Methods
Case studies and context
Program | PEACH™QLD | Go4Fun® |
---|---|---|
Evidence base | ||
Developer in Australia | Flinders University | Better Health Company |
Funder | QLD Department of Health | NSW Ministry of Health |
Commencement in Australia | 2013 | 2011 (phased scale-up from 2009) |
Eligibility criteria | 5–11-year-old (primary school aged) children above the healthy weight range for age (weight category removed in 2016); parent/carer available to attend each session | 7–13-year-old (primary school aged) children above the healthy weight range for age; parent/carer available to attend each session |
Cost to participant | Free | Free |
Venues | Community/school and health services | Community-based settings |
Format and content | 1.5 h face-to-face—healthy lifestyle changes through the development of parenting skills (parents only) and physical activity (child only); online option (2016) | 2 h face-to-face—1-h nutrition (parent/carer and child) + 1 h game-based physical activity (child)/discussion on facilitated behaviour change (parent/carer) Online option (in development) |
Frequency and timing | 1.5 h/week (15 h total) After school hours, during school term | 2 h/week (since 2014—previously 4 h/week) (20 h total) After school hours, during school term |
Duration | 6-month program of 9 weekly meetings with 10th meeting at 6 months post commencement; individualised family support by phone and text message between sessions 9 and 10 | 10-week program of 10 weekly meetings (since 2014) (prior: twice weekly meetings) |
Follow-up | Family handbook; website; Facebook page | Access to Active 8 Website; sent a quarterly newsletter for 12 months following completion |
Advertising and recruitment | QUT—website; Facebook; media; partnerships (NGOs, local government, health and non-health services); health professionals; local media; community groups Self-referral—via website or toll-free number | NSW health—website, Facebook Health services sites—local media, school newsletters, partnerships (NGOs, school nurses, health services, youth clubs, GPs) Self-referral—via toll-free number |
State-wide co-ordination | QUT—project manager | NSW Office of Preventive Health—State program manager |
State-wide monitoring | Flinders University | NSW Office of Preventive Health |
State-wide training and support | QUT and Flinders University 2-day facilitator training Ongoing access to program and evaluation support Contact made at the commencement and completion of each program | Better Health Company and NSW Office of Preventive Health 2-day face-to-face training for program managers and leaders Annual professional development day for program managers Professional development via webinars for leaders Regular support teleconferences |
Local co-ordination | Various (QUT, health services, tertiary institutions) | Health services through health promotion services |
Local delivery | Trained facilitators | Trained leaders |
State-wide evaluation | Flinders University | |
Program effectiveness | ⇑ Fruit intakes ⇑ Vegetable intakes ⇑ Physical activity ⇓ Screen time ⇓ BMI Z-score | ⇑ Fruit intakes ⇑ Vegetable intakes Decreases in sugar sweetened beverages ⇑ Physical activity ⇓ Screen time ⇓ BMI Z-score |
Program reach | 1122 children + 380 (online) (July 2013–June 2016) 501 children/annum | 7821 children (July 2011–June 2016) 1564 children/annum |
State prevalence: overweight and Obesity (2–17 years) [2] | 24.6 | 24.8 |
State prevalence: overweight (2–17 years) [2] | 17.9 | 16.9 |
State prevalence: obesity (2–17 years) [2] | 7.5 | 8.7 |
Theoretical framework
Domain | Construct |
---|---|
CFIR #1: Characteristics of intervention | #1.1 Intervention source development and implementation decision-making process #1.2 Strength and quality of evidence to support choice of intervention #1.3 Relative advantage of implementing intervention versus an alternative #1.4 Adaptability of intervention to meet local needs #1.5 Trialability of intervention prior to implementation #1.6 Complexity and difficulty of implementation #1.7 Design quality and packaging of intervention #1.8 Costs associated with implementation |
CFR #2: Outer setting (external organisational environment) | #2.1 Patient needs and resources met in relation to implementation barriers/enablers #2.2 Cosmopolitanism (organisation networks with other external organisations) #2.3 Peer pressure to implement intervention #2.4 External policy and incentives (mandates, strategies) to spread intervention uptake |
CFIR #3: Inner setting (internal organisational environment) | #3.1 Structural characteristics of the organisation, such as maturity, age and size #3.2 Networks and communications (informal or formal) within organisation #3.3 Culture, norms, values and basic assumptions of the organisation #3.4 Implementation climate (receptivity, compatibility, relative priority, incentives for change) #3.5 Readiness for implementation (leadership engagement and commitment, available resources, access to knowledge, information incorporated into work tasks) |
CFIR #4: Characteristics of program implementers (facilitators) | #4.1 Knowledge and beliefs about the intervention and value placed on intervention #4.2 Self-efficacy/belief in own capabilities to implement intervention to achieve goals #4.3 Individual stage of change (level of preparedness to implement intervention) #4.4 Individual identification with the organisation (relationship and commitment to organisation) #4.5 Other personal attributes (learning styles, capacity, competency, motivation, etc.) |
CFIR #5: Implementation process | #5.1 Planning processes for implementation #5.2 Engagement strategies (with opinion leaders, internal leaders, champions, external change agents, key stakeholders) #5.3 Executing according to implementation plan #5.4 Reflecting and evaluating (qualitative and quantitative feedback on progress) |
Study sample
Level of program implementation | Geographic location |
Total sites
| |||
---|---|---|---|---|---|
Major city | Inner regional | Outer regional | Remote | ||
PEACH™QLD sites (n = 8) | |||||
No implementation | 0 | 1 | 0 | 2 |
3
|
Discontinued implementation | 1 | 0 | 0 | 0 |
1
|
Repeated implementation | 1 | 1 | 2 | 0 |
4
|
Go4Fun® sites (n = 8) | |||||
No implementation | 0 | 0 | 0 | 0 |
0
|
Discontinued implementation | 0 | 0 | 1 | 2 |
3
|
Repeated implementation | 2 | 2 | 1 | 0 |
5
|
Total sites |
4
|
4
|
4
|
4
|
16
|
Study participants | Queensland (n = 27) | NSW (n = 23) | Total (n = 50) | |||
---|---|---|---|---|---|---|
State-level roles | ||||||
Funding | 2 | 2 | 4 | |||
Co-ordination | 1 | 1 | 2 | |||
Development | 1 | 1 | 2 | |||
Evaluation | 2 | 1 | 3 | |||
State: total participants |
6
|
5
|
11
| |||
Site-level roles | None (3 sites) | Discontinued (1 site) | Repeated (4 sites) | Discontinued (3 sites) | Repeated (5 sites) | |
Management | 0 | 1 | 5 | 3 | 3 | 12 |
Co-ordination | 3 | 1 | 4 | 3 | 4 | 15 |
Delivery | 3 | 1 | 3 | 0 | 5 | 12 |
Site: total participants
|
6
|
3
|
12
|
6
|
12
|
39
|
Data collection and analysis
Results
Common site-level enablers and barriers
Influence of geographic location
Influence of implementation model
Model of implementation | Level of program implementation | ||
---|---|---|---|
Never (3 sites) | Discontinued (4 sites) | Ongoing (9 sites) | |
QLD inner regional QLD remote QLD Remote | |||
a) Co-ordinated by health service; delivered by internal facilitators | QLD major city | QLD major city NSW inner regional | |
b) Co-ordinated by health service; delivered by contracted facilitators | NSW outer regional c,b NSW remote c,b NSW remote c,b | NSW major city NSW major city NSW inner regional NSW outer regional | |
c) Co-ordinated and delivered by other agency | QLD outer regional | ||
d) Delivered by contracted facilitators; no co-ordination role | QLD inner regional QLD outer regional c,d |