Accreditation and certification of theory and evidence-based health promotion interventions

The Center for Healthful Living (Centrum Gezond Leven) and the Netherlands Youth Institute of the Netherlands National Institute for Public Health and the Environment are coordinating and leading an effort to come to better evidence-based practice in health promotion interventions in the Netherlands. The Center has developed an accreditation and certification procedure to distinguish between health promotion efforts that have no empirical basis from interventions for which different levels of evidence is available. For this purpose the Certification Commission for Interventions was started. The commission has four sub commissions, one on health promotion interventions for adults, which I will chair.
In health promotion, most often developed to promote healthy life styles for primary prevention of chronic disease, a lot is going on, but most interventions have no or an insufficient evidence-base. Such a situation is regarded as unacceptable in secondary prevention, cure or care, where evidence-based medicine is key. No one would accept, for example, that a new vaccine for Swine Flu was distributed to the population at large without careful stepwise testing in well-designed and controlled studies (see attached figure). In health promotion this is, however, common practice (the second figure shows this): mass-media or more tailored health education and health promotion interventions are designed, maybe pretested in some form of formative research, but often disseminated without any proof of effects.
The efforts of the Center for Healthy Living are aiming to help professionals and policy makers to select the available more promising and more evidence-based interventions for their health promotion purposes. The establishment of the certification procedure should also encourage organisations that develop interventions to improve their quality control and evaluation efforts.
Four levels of evidence will be distinguished (between brackets a very brief summary of the true, much better described and more detailed criteria are provided, click here for a list of criteria in Dutch):
1. Theoretically sound: The intervention’s goals, strategy and methods are well described and based established theoretical models
2. Probably effective: a series (>2) of studies of medium level design strength should suggest effectiveness
3. Proven effective: at least 2 studies with a strong research design show effectiveness
4. Proven cost-effectiveness: additional economic evaluations are available.
In the coming years it will become clear if the system will indeed lead to better evidence-based practice in health promotion.

In memoriam: Prof Herman Schaalma

Professor Herman Schaalma died suddenly of a heart attack on 25 July 2009 while riding his road bike in the Limburg hills. Last Friday I joined a crowd of 400-500 people in Eijsden near Maastricht, the Netherlands, to say goodbye during an emotional, heart breaking, but sometimes also hilariously funny ceremony.

Herman was a social psychologist and health scientist working at the Faculty of Psychology and Neuroscience of Maastricht University in the field of planned development, implementation and evaluation of theory- and evidence-based health promotion programs, with a focus on HIV/Aids. His research focused on applying (social) psychology in understanding and changing health behaviors. His recent research interests included risk perception and communication; stigma; adherence; culture, psychology and health education; and web-based health education.

I worked with Herman during the time I was at Maastricht University and occasionally after I left Maastricht to work first in Rotterdam, and now at the EMGO Institute for Health and Care Research at the VU University Medical Center in Amsterdam. In fact when in Maastricht I lived for a few years under the same roof as Herman; I lived in an apartment one floor above Herman and his family. Herman was a great colleague and a great neighbour.

The most intensive collaboration we had was when the two of us, together with Prof. Gerjo Kok edited the first edition of the Dutch handbook on health education and behaviour change. Working with Herman in this way was fun, rewarding and challenging. Fun because of his great sense of humour, rewarding because he certainly made sure that we got the job done and his input improved the book in a great way, and challenging because his razor sharp feedback and comments, no beating around the bush, made sure that you wanted to do your best before asking Herman to take a look at your output.

The field of planned, evidence-based health promotion has lost a great colleague and a great character.

Overweight and obesity in infants and pre-school children in the European Union

As part of the Health promotion through Obesity Prevention across Europe (HOPE) study, Prof. Adriano Cattaneo and collegues have conducted a systematic review on overweight and obesity prevalence and trends in countries within the European Union. The paper based on this review was recently published as e-pub ahead of print in the journal Obesity Reviews.

The data sources used in the review included WHO databases, Medline and Google, as well as data derived through contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference
and cut-offs, as well as the WHO standard. The authors were able to derive data from 18 of the 27 countries. Comparisons between countries were problematic because of
different definitions and methods used in the varios reviewed studies.

The reported prevalence of overweight plus obesity at 4 years ranged from 11.8% in Romania to 32.3% in Spain. Countries in the Mediterranean region and the British islands reported the highest rates. Rates were generally higher in girls than in
boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20–30 years in the five countries that had some trend data available.
The authors conclude that data on overweight and obesity in pre-school children are scarce and their interpretation difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

ISBNPA 2009 keynote debate: industry sponsorship of scientific societies and scientific research

The closing session of ISBNPA 2009 was the keynote debate. This year Professors Willem van Mechelen of EMGO+ at the VU University Medical Center and David Crawford of C-PAN, Deakin University, Australia debated about industry sponsorship of behavioral nutrition and physical activity research/research society. David Crawford argued against and Willem van Mechelen argued in favour. Professor Knut Inge Klepp of the department of nutrition of University of Oslo chaired the session.
After an introduction by Klepp stating the importantce and relevance of this issue, Van Mechelen started his argument by playing 'The times they are a changing' by Bob Dylan and a hylarious introduction including a reference to Aussie style football; Crawford with a picture of Van Mechelen as a clown. But after that, things got serious. Van Mechelen pointed out that without industry sponsorship we would have far less scientific research, and thus less scientific progress. Basically, he argued that scientists cannot accomplish their goals and cannot meet their performance indicators if they are too restrictive in accepting funding for research. He showed that, with some exceptions, governments in general and the Dutch government in particular are not willing to invest enough in scientific research to help evidence-based practice to progress. He further argued that as long as the process is transparent and the sponsored research is methodological sound, and the right rules regarding the data, scietific independence, disclosure and publications are set, with no publication restrictions, the risks of bias because of industry sponsoring is very low.
Crawford argued that and showed that there is evidence that industry sponsorhips can bias research results, citing, amongst others, Lesser et al's 2007 publication in Plos Medicine. He also argued that perceptions matter: sponsorship by industry may make a scientific society or a sponsored study less credible, among fellow scientists, reviewers, stakeholders as well as the broader community. David's third argument was that industry sponsorhip is no longer common; tobacco industry sponsorship of research is nowadays unheard of, and there is a growing movement against pharmaceutical industry sponsorship. David agreed with Willem that intercation with industry is important, but this should be without financial ties. Basically, David Crawford argued that the cons for accepting industry sponsorship for ISBNPA outweigh the pros.
By the way, in the preparation of the ISBNPA 2009 meeting, the Executive Committee of ISBNPA decided to not accept sponsorship from a large softdrink company for support of the society. ISBNPA 2009 was supported by non-commercial sponsors only.

Prof. Ken Resnicow argues in favour of embracing complexity and chaos theory in behavioral nutrition and physical activity

Today at ISBNPA 2009, professor Ken Resnicow gave his key note address: Moving beyond linear models of behavior change; embracing complexity and chaos.
His key note was very thought provoking. He argued that that the behavioral nutrition and physical activity field has been guided by a cognitive, rationale paradigm, described in health behavior models and theories such as the Theory of Planned Behavior, Social Cognitive Theory, and the Trans Theoretical Model.
Dr. Resnocow claimed and presented preliminary evidence that we may need a paradigm shift to move the field forward, a shift towards embracing chaos theory and complex dynamic systems in our field. Key principles from these perspectives described by Dr. Resnicow are:
1. Behavior change is often quantum rather than linear
2. Behavior change is a chaotic process that is highly variable and difficult to predict
3. Behavior change is a complex dynamic system that involves multiple component parts that interact in a non-linear way
4. Behavior change is sensitive to initial conditions
Dr. Resnicow has published his line of thinking in two published papers, one in the International Journal of Behavioral Nutrition and Physical activity, and one in the American Journal of Public Health. Click here for the IJBNPA paper and here for a reaction by Tom Baranowski and here for one by myself. The reference to the more recent paper by Resnicow in AJPH can be found here.

ISBNPA 2009 will start today

This evening the annual meeting of the International Society of Behavioral Nutrition and Physical Activity will start with an opening reception and a keynote lecture Shiriki Kumanyika. ISBNPA 2009 is at a great venue in Cascais, near Lisbon, Portugal. Today four different preconference workshops are ongoing on Introducing Intervention Mapping, conceptualising and measuring the build environment, early career mentoring, and on the role of advocacy in behavioral nutrition and physical activity.
The 2009 annual meeting will set another record; more than 600 delegates will be in Cascais to be informed and discuss the latest research in behavioral nutrition and physical activity. The local organising committee chaired by Pedro Teixeira, and the program committee chaired by the incoming president, Stuart Biddle have done a fantastic job.

Nicole Vogelzangs wins the annual publication price from the Netherlands Epidemiology Society at the annual WEON meeting in Amsterdam.

EMGO+ congratulates Nicole Vogelzangs with winning the annual publication price from the Netherlands Epidemiology Society. Nicole, who is completing her PhD within the EMGO Institute for Health and Care Research at the department of psychiatry, received the price for her paper ‘Depressive symptoms and change in abdominal obesity in older persons’, published in Archives of General Psychiatry.