Table 2 Study characteristics and quality assessment of included studies
Author, year | Study setting | Policy level | Policy focus area | ‘Stages’ of policy processes investigated (agenda setting, policy formulation, implementation; evaluation; or any combinations of the above) | Design and methods | Study participant information | Critical appraisal ratinga | Other strengths/ limitations (e.g., sampling strategy; ethics approval) | |||
|---|---|---|---|---|---|---|---|---|---|---|---|
Credibility Do the findings represent the views of participant? | Transferability Were there contextual details provided? | Dependability Was the process logical, traceable? | Confirmability Are findings qualitatively confirmable through an analysis of audit trail? | ||||||||
Craig et al. 2010 [68] | Arkansas, United States of America (USA) | State level | Healthy eating environment policy Legislation to support healthy eating. The Act 1220 including the following components: • Child Health Advisory Committee (Education and Health representation). • Local regional schools PA and nutrition committee • State wide screening of BMI reporting back to parents • Vending machine legislation (restrictions) • Community health professionals within school setting | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative using secondary document data collected as part of a comprehend-sive evaluation of Arkansas Act 1220. Key informant interviews were also conducted with persons knowledge-eable of or involved in the passage of Act 1220. | No details were provided regarding study participants demo-graphics. | M | M | M-H | L | Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced. No details regarding ethics approval. |
Dodson et al. 2009 [69] | Multiple states across USA | State level policy making (across several states) | General childhood obesity prevention legislation. Not a specific policy or set of policies. | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative study using interviews | There were 16 participants from 11 states, from various political parties, their professional background and length of tenure within their organisation, and geographical area represented also varied. | H | M-H | M | L | This was not a study of a specific policy process but rather of obesity prevention policy processes generally. |
Freundenberg et al. 2015 [62] | Comparison of London and New York | Municipal level | Food policies, which included strategies to reduce obesity | Focused on election cycles providing opportunities for policies to be developed, and hence to stage of policy adoption only. | Document analysis | NA- document analysis | M | L-M | L | L | Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced. |
Gladwin et al. 2008 [70] | Alberta, Canada | Provincial and local (local school board networks) and individual school level. | Daily physical activity mandatory requirements in schools as well as policy processes relating to decisions to not adopt the walking to school bus program. | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative comparative study of case study of two policies. Collected interviews (primary data) and documents related to the policy (secondary data). | None provided. | M | L-M | M | L | Only four of the interviewees were from the provincial level. The remainder were with parents, health professionals or school board members. |
Gomez, 2015 [51] | Comparative study of USA and Brazil | National policy level | General obesity prevention policy. | Stages not specified however long term perspective allowed consideration of all aspects of the policy process (including feedback feeding into subsequent decision making) | Qualitative comparative case study drawing on secondary data sources of various documents (peer reviewed journal articles, government documents, and reports) | NA- document analysis | L | M | M | L | Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced. |
Houlihan et al. 2006 [52] | England, and Wales, United Kingdom (UK) | National policy level | Policy focused on incorporation of physical activity/sport into school curriculum | Not specified however the use of two ‘synthesis’ theories could potentially include all ‘stages’ | Qualitative study drawing on key informant interviews. | Nine participants in total, Including senior civil servants or senior members of interest/ professional organizations or senior academics. | M | M-H | L | L | No information regarding ethics approval. |
Khayesi et al. 2011 [71] | Curitiba, Brazil | State level policy | Transport sector policy to increase active transport (through car dependence reduction policies) | No stages specified | Historical case study utilising documents. Two key informants assisted to inform the selection process of documents but did not provide any primary data. | NA- Document analysis | L-M. | M | L-M | L | Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced. |
McBeth et al.2013 [72] | USA | Federal level policy | Obesity prevention policy generally | Agenda setting and the potential subsequent influence on policy formulation | Cross-sectional study documents (newspaper articles) using content analysis | NA- document analysis | H | H | H | L | Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced. |
Milton et al. 2015 [75] | England, UK | National level policy | Walking promotion policy | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative case study drawing on document analysis and interview | Participants included representatives from relevant government departments and not for profit organisations, as well as, several independent consultants and other known advocates. | H | H | H | L | Details of ethics approval provided. |
Mosier et al. 2013 [64] | USA, states of Colorado and Kansas | State level | Sales and excise tax policy on Sugar Sweetened Beverages (SSB) | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative comparative study, utilising observations, interviews and document analysis. | Nine individuals, involved in the policy processes were interviewed. No further details were reported. | M-H | M | M-H | L | No information regarding ethics approval. |
Olstad, et al. 2015 [73] | Canada | State and provincial level | School based physical activity policy (legislation, rules, requirements) | All stages of policy process (including implementation) | Historical multiple case study. Systematic document review was used (no interviews or observation) | NA- no interviews | H | H | H | L | Secondary data source means that the theory did not inform the type of questions that were asked, potentially limiting what was able to be deduced. |
Phillpots, 2012 [53] | England, United Kingdom | National policy | Sport and physical activity integration into school curriculum | All stages of policy process (including decision to cease the implemented policy) | Qualitative study design, drawing upon interviews, and document analysis. | Twenty-three interviewees from a range of government sport and education agencies who had been involved in the policy area for at least 5Â years. | H | M | L-M | L | No information regarding ethics approval. |
Quinn et al. 2015 [65] | King County, Washington, USA | Local level | Non-regulatory nutritional guidelines for food and beverages sold in vending machines. | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative case study design, using focus group, interview, and document review methods. | Focus groups: local health department staff interviews: Local Board of Health members, local elected, municipal staff, department directors officials, health expert from across 5 local jurisdictions | M | L | M-H | L | Ethics was obtained and details of the duration and timing of the interviews were given. |
Reid and Thornburn 2011 [54] | Scotland, United Kingdom | National level | Physical education and activity policy | No stages specified, although clear focus on agenda setting | Field research involved key informant interviews | Participants from: various government departments (education, sport), local government sports development staff, relevant peak bodies, not for profit organizations, and politicians. | H | M-H | M-H | M-H | No information regarding ethics approval. |
Thow et al. 2014 [63] | Ghana | National Level | A food standards policy to limit the amount of fat in meat and meat cuts | All stages from agenda setting, formulation, adoption and evaluation | Mixed methods case study | Participants were policy makers, implement-ers, producers, processors and retailers and respresented numerous government departments and stakeholder groups/ organisations | M | H | M | L | Ethics was obtained. |
Ulmer et al. 2012 [74] | New Orleans, USA | State level | A Fresh Food Retailer policy Initiative | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Qualitative study using interviews | Participants were from various organizations and included city agency staff, city council members, grocers, representatives from trade associations and fınancial institutions, public health professionals, and food advocates. | L-M | L-M | L | L | No information regarding ethics approval. |
Yeatman, 2003 [76] | Australia | Local level policies (four case studies) | Food policy | Stages of focus not specified however appears to focus on policy process stages leading to policy adoption (i.e., agenda setting and policy formulation) | Case studies using interviews and document analysis | Participants included local food policy councils, local elected members and local government middle managers. | L-M | M | L | L | No information regarding ethics approval. |