Evaluation of intervention processes: physical activity during pregnancy and postpartum
DOI:
https://doi.org/10.5020/18061230.2020.9635Keywords:
Process Assessment (Health Care), Primary Health Care, Motor Activity, Pregnancy, Social ProgramsAbstract
Objective: To evaluate the process of an intervention on physical activity during pregnancy and postpartum. Methods: In the context of a social program that fights extreme poverty, the beneficiaries (n=927) receive an intervention that consists of the promotion of the practice of physical activity, through counseling, workshops, and educational materials. During 2008-9, 2010 and 2012, we visited health units from urban and rural areas, randomly selected from four states of Mexico. Health service providers collected process data during observation of consultations and through the application of questionnaires to the beneficiaries. Four indicators of implementation of the intervention were studied: fidelity to the planned activities, dose delivered to the population, scope of the target population, and reception of the intervention by pregnant women and postpartum women. Results: Health units were visited in the initial (n=91), intermediate (n=47), and final (n=82) stages of the study. The delivered dose showed an implementation level of 81-86%. Fidelity had <50% implementation and significant improvements were observed in most analyzed aspects between the different stages of the study, such as training of health service providers, the supply of materials, counseling, and workshops in health units. Conclusion: Important Implementation and contextual challenges were observed for the effective fulfillment of the intervention of physical activity into primary healthcare services.Downloads
References
World Health Organization. Global Action Plan on Physical Activity 2018-2030: more Active People for a Healthier World. Geneva: WHO; 2018.
Lozada AL, Campero L, Hernández B, Rubalcava L, Neufeld LM. Múltiples factores individuales, comunitarios y ambientales limitan la práctica de actividad física durante el embarazo y posparto en mujeres pobres de México. Salud Pública Mex. 2015;57:242-51.
International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical activity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: meta-analysis of individual participant data from randomized trials. BMJ. 2017;358:j3119.
Peters D, Tran N, Adam T. Implementation research in health: a practical guide. Geneva: WHO; 2013.
González W, Bonvecchio Arenas A, García-Guerra A, Vilar-Compte M, Villa de la Vega A, Quezada L, et al. An iterative process for training design and implementation increased health workers knowledge for tacking nutrition behavior change to scale. J Nutr. 2019;149(S1):2323S-31S.
Robert RC, Gittelsohn J, Creed-Kanashiro HM, Penny ME, Caulfield LE, Narro MR, et al. Process evaluation determines the pathway of success for a health center-delivered, nutrition education intervention for infants in Trujillo, Peru. J Nutr. 2006;136:634-41.
Secretaría de Bienestar (MEX). Reglas de Operación del Programa Prospera (antes Programa de Desarrollo Humano Oportunidades) [Internet]. México: Gobierno de México; 2019 [Acesso em 2020 Jan 29]. Disponível em:
https://www.gob.mx/cms/uploads/attachment/file/442955/Reglas_de_Operacion_PROSPERA_2019.pdf
Tougas ME, Hayden JA, McGrath PJ, Huguet A, Rozario S. A systematic review exploring the social cognitive theory of self- regulation as a framework for chronic health condition interventions. PLoS ONE. 2015;10(8):1-19.
Maibach EW, Rothschild ML, Novelli WD. Social marketing. In: Glanz K, Lewis RM, Rimer BK, editores. Health behavior and health education: theory, research and practice. San Francisco, CA: Jossey-Bass; 2002. p. 437-61.
Shuval K, DiPietro L, Skinner CS, Barlow CE, Morrow J, Goldsteen R, et al. Sedentary behavior counselling: the next step in lifestyle counselling in primary care; pilot findings from the Rapid Assessment Dissue Index (RADI) study. Br J Sports Med. 2014;48(19):1451-5.
Menon P, Covic MN, Harrigan BP, Horton ES, Kazi MN, Lamstein S, et al. Strengthening implementation and utilization of nutrition interventions through research: a framework and research agenda. Ann N Y Acad Sci. 2014;1332:39-59.
Tumilowicz A, Ruel MT, Pelto G, Pelletier D, Monterrosa E, Lapping K, et al. Implementation Science in Nutrition: Concepts and Frameworks for an Emerging Field of Science and Practice. Curr Dev Nutr. 2018;3(3):nzy080.
French J. Key concepts, principles and techniques of social marketing. In: Social marketing and public health: theory and practice. New York, NY: Oxford University Press; 2017. p. 17-25.
Hernández-Ávila M, editor. Epidemiología. Diseño y análisis de estudios. Cuernavaca, MEX: Instituto Nacional de Salud Pública; 2015.
Bonvecchio Arenas A, González W, Théodore FL, Lozada-Tequeanes AL, Garcia-Guerra A, Alvarado R, et al. Translating evidence-based program recommendations into action. The design, testing and scaling up of the behavior change strategy EsIAN in Mexico. J Nutr. 2019;149:2310S-22S.
Robert RC, Creed-Kanashiro HM, Villasante R, Narro MR, Penny ME. Strenghtening health services to deliver nutrition education to promote complementary feeding and healthy growth of infants and young children: formative research for a successful intervention in peri-urban Trujillo, Peru. Matern Child Nutr. 2017;13(2):1-15.
StataCorp. Stata Statistical Software: release 12. College Station, TX: StataCorp LP; 2018.
Consejo Nacional de Evaluación. Modelo de términos de referencia de Evaluación de Procesos [Internet]. Ciudad de México: CONEVAL; 2017 [consultado em 10 Jan 2016]. Disponible en: https://www.coneval.org.mx/Evaluacion/MDE/Documents/TDR_Procesos.pdf]
Prasad K, Poplau S, Brown R, Yale S, Grossman E, Varkey AB, et al. Time pressure during primary care office visits: a prospective evaluation of data from the healthy work place study. J Gen Inter Med. 2019.
Neufeld LM. Diseño y fortalecimiento programático basado en evidencia: el caso de nutrición en el programa Progresa-Oportunidades-Prospera. In: Hernández LG, De la Garza TZ, Janet-Yaschine I. El Progresa-Oportunidades-Prospera: a 20 años de su creación [Internet]. Ciudad de México: CONEVAL; [fecha desconocida]. Disponible en: https://www.coneval.org.mx/Evaluacion/IEPSM/Documents/Libro_POP_20.pdf
Delisle H, Shrimpton R, Blaney S, Du Plessis L, Atwook S, Sanders D, et al. Capacity-building for a strong public health nutrition workforce in low-resource countries. Bull World Health Organ. 2017;95:385-8.
Shojania KG. Conventional evaluations of improvement interventions: more trials or just more tribulations? BMJ Qual Saf. 2013;22(11):881-4.
Dickey VC, Pachón H, Marsh DR, Lang TT, Claussenius DR, Dearden KA, et al. Implementation of nutrition education and rehabilitation programs (NERPs) in Viet Nam. Food Nutr Bull. 2002;23(4 Suppl):78-85.
Neufeld LM, Grados R, Villa de la Vega A, Steta C, Regalia F, Rivera-Dommarco JA. A brief history of evidence-informed decision making for nutrition in Mexico. J Nutr. 2019;149:2277S-80S.
Mohan V, Shanthirani CS, Deepa M, Datta M. Community empowerment: a successful model for prevention of non-communicable diseases in India: the Chennai Urban Population Study (CUPS -17). J Assoc Phys India. 2006;54:858-62.
Paul KH, Olson CM. Moving beyond quantity of participation in process evaluation of an intervention to prevent excessive pregnancy weight gain. Int J of Behavioral Nutr and Phys Act. 2013;10:8-11.
Kinnunen TI, Aittasalo M, Koponen P, Ojala K, Mansikkamaki K, Weiderpass E, et al. Feasibility of a controlled trial aiming to prevent excessive pregnancy-related weight gain in primary health care. BMC Pregnancy Childbirth. 2008;8:37.
Poblete CM. Métodos mixtos: una aproximación a sus ventajas y limitaciones en la investigación de sistemas y servicios de salud. Rev Chil Salud Pública. 2013;17(3):218-23.
Östlund U, Kidd L, Wengstro¨m Y, Rowa-Dewar N. Combining qualitative and quantitative research within mixed method research designs: a methodological review. Int J Nurs Stud. 2011;48:369-83.
Gillespie S, Menon P, Kennedy AL. Scaling up impact on nutrition: what will it take? Adv Nutr. 2015;6(4):440-51.
Schnelle JF, Ouslander JG, Simmons SF. Direct observations of nursing home care quality: Does care change when observed? J Am Med Dir Assoc. 2006;7(9):541-4.
Sharma S, Adetoro OO, Vidler M, Drebit S, Payne BA, Akeju DO, et al. A process evaluation plan for assessing a complex community-based maternal health intervention in Ogun State, Nigeria. BMC Health Serv Res. 2017;17(1):238.
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