The methodology to address the aims is summarised below:
I. Identify individual-level, environmental-level and multi-level entry points for approaches aimed at changing obesogenic behaviours and environments
The published scientific literature will be systematically reviewed to identify consistent individual-level self-regulation predictors of success in preventing obesity in clinical and community behaviour change interventions. Emphasis will be placed on factors (such as skills, motivation, perceptions, or goals) found to moderate or mediate the effect of interventions on selected outcomes (e.g. body weight, physical activity, sedentary behaviour, eating behaviour). The published literature on both the social and physical environmental determinants of overweight and obesity will also be systematically reviewed. The methodology for conducting the three reviews will follow the guidelines as described in the Cochrane Handbook for Systematic Reviews of Interventions
]. If appropriate, meta-analytical procedures will be conducted. European as well as non-European studies published since 1995 will be included.
In addition, other methods to address this aim involve 1) the development of an instrument that can be used to assess dimensions of an obesogenic (physical) environment (e.g. walkability, access to food outlets etc.) using remote imaging (data extracted from photographs and geo-localized) and 2) a survey in four countries to assess lifestyle and perceptions of the environment of residents. The work will be conducted in several steps:
Conduct a systematic literature review to identify emerging techniques based on remote satellite imaging to assess measures related to obesogenicity of the environment and the quality of the built environment;
Develop a protocol for data extraction from Google Earth/Streets and test its inter-rater reliability in a selection of neighborhoods in different European countries.
Select 120 neighbourhoods (30 per country, stratified by internationally relevant socio-economic parameters) in four European countries (United Kingdom, Hungary, France and the Netherlands) and conduct a survey on measures related to obesogenicity, using an instrument such as the Environmental Profile of a Community's Health (EPOCH)
]. Using this instrument has been shown to collect reliable information about the community environment from a variety of settings
Link the environmental obesogenicity measures obtained through remote imaging with collected data on obesity, lifestyle factors and perception of the environment in selected areas in four European Member states.
II. Assess multi-level intervention approaches using the RE-AIM framework;
The published scientific literature on the RE-AIM of multi-level intervention approaches to changing obesogenic behaviours in adults will be systematically reviewed. The review will be conducted following the Cochrane methodology. In addition, the RE-AIM of multi-level intervention approaches that are currently being implemented across Europe will be evaluated using a comprehensive cross-European survey. This will result in an interactive web-atlas of multi-level efforts. The following steps will be taken to do this:
Collect existing overviews of recent-and currently implemented multi-level intervention approaches aimed at changing obesogenic behaviours in adults;
Develop a draft atlas of known multi-level intervention approaches, including their general characteristics and their RE-AIM;
Circulate the draft atlas in a small sample of key policy makers and health professionals in a selection of European Member States, and adjust it if needed by adding relevant projects and details;
Further distribute the atlas to policy makers and health professionals in all European Member States (to be reached via the IASO-IOTF and EASO networks) to correct errors and identify any gaps. Accompanying information and instructions will be translated to the relevant national languages of those policy maker and health professionals;
Finalise the web-atlas using the complementary information gathered via the previous step.
III. Identify success-and failure factors for implementation of multi-level intervention approaches
A selection of the best examples of effective multi-level approaches in neighbourhoods as identified through the above described methodology will be further studied to address this aim. Quantitative methods will be combined with qualitative methods to reveal factors that enhance or impede implementation and usage of multi-level interventions. The methodology for this has been broken down into the following steps:
Develop a set of parameters to select case studies. The parameters will include intervention characteristics (obesity related, multi-level, integrated), geographical (e.g. Denmark, United Kingdom, Netherlands), and economic status/stage in austerity measures;
Establish which process-frameworks could potentially be used to obtain more in depth insights into determinants that affect the success or failure of implementing multi-level obesity intervention approaches;
Pilot test the developed methodology with an intervention that meets the agreed parameters;
Undertake in-depth research within the selected case study areas with those involved in supporting, delivering, and managing the different levels and components of the intervention to obtain the insights needed e.g. regional and national authorities, community groups, policy makers, nongovernmental organizations, municipal authorities;
If relevant to the interventions selected in the case studies, undertake qualitative research involving consumers;
Compare outcomes between variables – e.g. differences related to geographical characteristics or socioeconomic status.
IV. Provide an evidence-based model for effective multi-level intervention approaches in health promotion practice applicable across the European region, and disseminate the findings to stakeholders in European Union Member States
All findings will be translated to a handbook with evidence-based as well as practice-based instructions, suggestions and references to effective and ineffective practice. The dissemination and take-up of findings to the main stakeholders will be facilitated: policy makers, governmental professionals, NGOs, private sector, the scientific community, the media, and other key elements and opinion leaders within the general public. Dialogue with policy-makers will be encouraged through a symposium on the use of evidence in policy-making, and the need for different forms of evidence in the development of health promotion strategies, to be held in the final year of the project. In addition, as the project progresses, a variety of social media platforms (e.g. LinkedIn, Facebook, Twitter) will be considered to encourage discussion of the findings and their relevance among different stakeholders, with opportunities for feed-back to be integrated into SPOTLIGHT outputs. The subject matter should ensure strong interest and engagement across all targeted audiences.
The study protocol was approved by the Medical Ethics Committee of the VU University Medical Center in Amsterdam.