Bridging the Gap: Using Dissemination and Implementation Science to Improve Obesity Treatment Access and Care

Jacqueline Hayes, PhD; Stephanie Hooker, PhD, MPH; Jennifer Mandelbaum, MPH; Sara Hoffman-Marchese, PhD & Gayle Timmerman, PhD RN, CNS, FNAP, FAAN

On behalf of the Obesity and Eating Disorder Special Interest Group

Evidence-based multicomponent behavioral interventions are recommended for children and adults with obesity^{1, 2}. However, most individuals who attempt weight loss do so without consulting a health professional, and only 4% engage in supervised, evidence-based care³. This gap in obesity treatment is at least partially due to a dearth of evidence-based interventions in clinical care settings. Difficulties with translation are not unique to the obesity field; it takes an estimated 17 years to translate evidence-based practices to clinical care⁴. Implementation science, which studies the techniques and strategies that are most helpful in moving evidence-based practices into practice and policy, can be utilized to increase obesity treatment access and care. This article will review the pillars of implementation science and provide some examples of how they may be leveraged to systematically and scientifically translate obesity interventions.

In order to bridge this translation gap, the first step is to identify the barriers and facilitators to implementing obesity treatment. Multiple methods (e.g., quantitative, qualitative) can be used to gather data, including from key advisors (e.g., clinicians, administrators, payers). Implementation science also uses theories, models, and frameworks that contextualize barriers and facilitators and can be used to guide efforts⁵. For example, the MOVE! Program has used the Consolidated Framework for Implementation Research to understand factors associated with successful and less successful program implementation within 5 Veterans Affairs medical centers⁶.

Once barriers and facilitators are identified, implementation strategies are selected to optimize implementation efforts. Numerous implementation strategies have been outlined, such as mapping out implementation procedures, identifying champions, restructuring workflows, or changing policies e.g.,⁷. These strategies are used to impact implementation outcomes, which include acceptability, appropriateness, and feasibility of the treatment, uptake and penetration in clinical care, fidelity to and costs of treatment delivery, and sustainability of the intervention over time⁸. An obesity-specific example is an ongoing pragmatic effectiveness-implementation trial that will test whether the implementation strategies of additional training and online clinician support tools for nurse care managers improves patient referral, enrollment, and completion of an online behavioral weight loss treatment in primary care⁹.

There is also growing recognition of the need to adapt interventions to the contexts and populations in which they will be implemented. Adaptations of an intervention, generally frowned upon in randomized-controlled trials, can improve effectiveness and implementation¹⁰. Using a thoughtful approach directed by established guidelines¹¹ and documenting and evaluating adaptations¹² will help to increase the validity and generalizability of knowledge. For instance, the Rhode Island CORD 3.0 project is systematically adapting an evidence-based childhood obesity treatment intervention to improve access and outcomes for under-resourced families by offering the treatment through federally-qualified health centers and low-income housing authorities¹³.

Obesity disproportionately affects marginalized communities¹⁴, and health equity must be considered within each of the aforementioned implementation science components^{15, 16}. If not, implementation efforts may widen existing disparities, improving care only for privileged groups. Moreover, awareness of evidence-based obesity treatments will not spread passively. Dissemination science is the study of how to most effectively circulate information and intervention materials to targeted audience and provides strategies to most efficiently and effectively use dissemination efforts¹⁷. The new SBM Science Communication Toolkit can help facilitate the spread of knowledge and awareness of obesity treatments. 

Efforts to implement and disseminate obesity treatments into clinical and community settings are critical to addressing gaps in patient access and care. Using implementation science processes and techniques can facilitate our understanding of how best to approach these translation efforts.

References: 

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